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Fat Embolism

Fat Embolism. Cindy Fehr Malaspina University-College BSN Nursing Program Nursing 335 – Fall 2005. FES Facts. Major cause of delayed recovery & mortality after limb # Highest incidence with # long bones (femur, tibia, ribs, fibula, pelvis)

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Fat Embolism

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  1. Fat Embolism Cindy Fehr Malaspina University-College BSN Nursing Program Nursing 335 – Fall 2005

  2. FES Facts • Major cause of delayed recovery & mortality after limb # • Highest incidence with # long bones (femur, tibia, ribs, fibula, pelvis) • Up to 90% with multiple trauma may develop FES although exact incidence unknown • Estimated 20% mortality rate (higher for older adults & those with multiple co-morbidities) • Typically seen 24-72 hrs post-injury • Other causes  blunt trauma, parenteral lipid infusion, acute pancreatitis, diabetes, burns, liposuction, cardiopulmonary bypass, decompression sickness, sickle-cell crisis

  3. Signs & Symptoms • Irritability • Restlessness • Tachypnea • Tachycardia • Changes in mental status • Diffuse crackles (late finding) • Dyspnea • Hypoxia • Fever • Petechiae in vest distribution

  4. Etiology Theories • Release of fat globules from bone marrow into venous circulation after # & spread to various organs (lungs, brain, kidneys) producing ischemia & inflammation • Hormonal changes d/t trauma cause release of fatty acids & neutral fats with platelet aggregation & fat globule formation as a result • Exact pathophysiology unknown

  5. Pathophysiology • Depending on where FE lodges determines effect  effects range from mild & undetectable to severe & life-threatening (lead to ARDS, MODS, death) • Into pulmonary circulation  disorder similar to ARDS  perfusion pressures , pulmonary vessels engorge  lungs more rigid, workload to Rt side heart s • Fat globules occluding pulmonary circulation hydrolize into free fatty acids  lodge in pulmonary vessels, injure endothelial tissue   microvascular permeability  pulmonary edema & activate lung surfactant  hemorrhagic pulmonary edema & patchy alveolar collapse  severe hypoxia

  6. Prevention • Prudent tx of long bone fractures • Careful handling & avoiding unnecessary manipulation of injured area  immobilization of unstable #s • Appropriate splinting • Prompt surgical fixation (within 24-48 hrs is best) • Early aggressive resuscitation to prevent hypovolemia • Adequate pain management

  7. Diagnostics • No one specific test or definitive manifestation • CXR, ABGs, CT, VQ scan • Multi-system review of clinical findings • Gurd’s Criteria Framework • One major/three minor criteria OR two major/two minor criteria Major Criteria • Nonpalpable reddish brown petechial rash over upper body in vest distribution (especially axilla)  within 24-36 hrs post-injury & resolves quickly • Respiratory symptoms  bilateral CXR changes, tachypnea, dyspnea, hypoxia • Cerebral signs without cause  agitation, seizures, coma

  8. Diagnostics cont. • Gurd’s Criteria Framework cont. Minor Criteria • Tachycardia • Temperature > 101.3 °F (38.5 °C) • Retinal hemorrhages with emboli present in retina with opthalmoscopic examination • Fat globules in urine or sputum • Sudden  Hgb & HCT & Platelet count •  sedimentation rate

  9. Treatment • Supportive treatment of respiratory function • High Fowler’s position • O2, DB&C to minimize atelectasis & improve pulmonary function • Intubation, CPAP • Steroids  controversial use to  inflammatory effects • Fluid volume replacement  prevent circulatory instability • u/o > 30 ml/hr; MAR > 60 mm Hg  helps prevent shock, perfuse kidneys, prevent mobilization of fat • Support other organs effected  renal, hepatic…

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