FAT EMBOLISM SYNDROME

SANIYAH BINTI ALMUHSIN

ORTHOPEDIC DEPARTMENT
 DEFINITION
• Fat embolism: a process by which fat droplets or particles
passes into the bloodstream and lodges within a blood vessel
• Fat embolism syndrome (FES): serious manifestation of fat
embolism occasionally causes multi system dysfunction
involving respiratory, dermatological and neurological
symptoms
HOW IT HAPPENS?
CAUSES
 PATHOPHYSIOLOGY

• MECHANICAL THEORY

• BIOCHEMICAL THEORY
 MECHANICAL THEORY
Obstruction of vessels and capillaries
• Increase in intermedullary pressure forces fat
and marrow into bloodstream
• Bone marrow contents enter the venous
system and lodge in the lungs as emboli
• Smaller fat droplets may travel through
pulmonary capillaries into the systemic
circulation affecting other systems
 BIOCHEMICAL THEORY
Toxicity of free fatty acids
• inflammatory response to trauma causes the release of
free fatty acids (FFA) from bone marrow into venous
system.
• elevated FFA as well as the inflammatory mediators
cause damage to capillary beds.
• Circulating free fatty acids directly affect the
pneumocytes, producing abnormalities in gas exchange
causing hypoxemia

• Regardless of the mechanism initiating fat embolism

end result is an intense inflammatory response.
 CLINICAL MANIFESTATION
• typically presenting 12 to 72 hours after the initial insult.
• The classic triad of FES includes hypoxemia, neurological abnormalities, and petechiae.
1. Pulmonary (most common initial signs)
-dyspnea
-tachypnea
-hypoxemia
2. Neurological
-focal deficits,
-confusion
-restlessness
-coma.
3. Dermatological
-petechial rash in nondependent regions (conjunctivae, head, neck, anterior thorax, or
axillae)
nonspecific - fever and retinopathy
hematologic -Thrombocytopenia and anemia
complicated by disseminated intravascular coagulation due to excessive tissue factor expression after
trauma, acute respiratory distress syndrome, shock, and death.
 DIAGNOSIS
clinically preferable
Gurd and Wilson's criteria
• Schonfeld's scoring system for FES
• Lindeque's criteria for FES
 INVESTIGATION

LABORATORY
• ABG
• Hematological test
• Biochemical test
• Urine and sputum examination
RADIOLOGY
• Chest x-ray
-multiple flocculent shadows (snow storm appearance), picture may be
complicated by infection or pulmonary edema

• CT Scan brain
-may be normal or diffuse white matter petechial haemorrhage
• Helical CT Scan chest
-may be normal as the droplets are lodged in capillary bed. Can detect
lung contusion, acute lung injury or ARDS
 MANAGEMENT
• PROPHYLAXIS
-adequate fluid resuscitation and maintenance of hydration (avoid developing
shock)
-immobilization and early fixation of fracture
-high index of suspicion
-corticosteroid is controversial
-DVT prophylaxis

• TREATMENT
-suppportive care-cardiovascular and respiratory issues
-maintain good oxygenation
-maintainenance of intravascular volume
-(albumin is recommended as restore blood volume and binds with FFA)
-heparin (stimulate lipase but no use evidence)
-adequate analgesia
 PROGNOSIS
• Most death contributed to pulmonary
dysfunction
• Difficult to determine exact mortality rate
• Estimated less than 10%
 CONCLUSION
• FES most coomonly presents with respiratory
distress in ortopedic trauma patients
• No specific diagnostic tests or criteria exist, so
the syndrome is most often diagnosis of
exclusion
• Certain traumatic and infective condition need
to be attended with urgency
• Be alert- always have a high suspicion
THANK YOU
 REFERENCE
• https://www.ncbi.nlm.nih.gov/pmc/articles/P
MC2700578/
• http://circ.ahajournals.org/content/131/3/31
7#ref-2
• http:/drhussainaftab/fat-embolism-syndrome-
51257084