Fat embolism

Fat embolism

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Provide a brief summary of this comorbidity here.

Pathophysiology

Fat embolism syndrome (FES) is a physiologic response to fat embolism. While fat embolization is quite common, likely occurring in nearly all patients with a femoral or pelvic fracture, fat embolization syndrome occurs in less than 1% of these patients. FES may develop over 12-72 hours or may present as fulminant disease with respiratory failure and cardiac arrest. A diagnosis based on the Gurd diagnostic criteria requires the presence of fat microemboli in the blood along with 1 major (respiratory insufficiency, cerebral involvement, or petechial rash) plus 4 minor criteria (pyrexia, tachycardia, retinal changes, jaundice, or renal changes).

Signs and symptoms

A petechial rash is considered pathognomonic for the syndrome and can be seen on conjunctiva, oral mucosa, and skin folds. Although mild hypoxia is common, less than 10% of patients with FES develop acute respiratory distress syndrome (ARDS). The pathophysiology of FES likely involves both the obstruction of end-organ capillaries by microemboli along with a systemic inflammatory response. Large emboli may cause segmental wall motion abnormalities, elevated pulmonary artery pressures, right ventricular dysfunction, and cardiac arrest.

Treatment

Treatment of fat embolism syndrome consists of supportive care and early resuscitation with prompt supplemental oxygen and intubation if necessary.

Prognosis

Most symptoms resolve within 3-7 days.

References

Schonfeld SA, Ploysongsang Y, DiLisio R, et al. Fat embolism prophylaxis with corticosteroids. A prospective study in high-risk patients. Ann Intern Med. 1983;99(4):438-443. doi:10.7326/0003-4819-99-4-438

Gurd AR, Wilson RI. The fat embolism syndrome. J Bone Joint Surg Br. 1974;56B(3):408-416.