Fat Embolism Clinical Presentation
- Author: Constantine S Bulauitan, MD; Chief Editor: Vincent Lopez Rowe, MD more...
The history of a patient with fat embolism may include the following:
Major blunt trauma, usually resulting in long-bone fractures, pelvic fractures, or both
Elective long-bone orthopedic procedures or cardiothoracic procedures
Parenteral lipid infusion
Recent corticosteroid administration
Gurd and Wilson have outlined an approach to diagnosing fat embolism syndrome (FES) on the basis of major and minor criteria. One major criterion, four minor criteria, and the presence of macroglobulinemia are required for the diagnosis.
Major criteria for diagnosing FES are as follows:
Symptoms and radiologic evidence of respiratory insufficiency
Cerebral sequelae unrelated to head injury or other conditions
Minor criteria are as follows:
Tachycardia (heart rate >110 beats/min)
Pyrexia (temperature >38.5° C)
Retinal changes of fat or petechiae
Acute drop in hemoglobin level
Elevated erythrocyte sedimentation rate
Early signs of the systemic inflammatory response syndrome (SIRS) may herald the onset of FES. Tachypnea, dyspnea, and hypoxia appear as a result of ventilation-perfusion abnormalities 12-72 hours after injury.
Alert clinicians may notice reddish-brown nonpalpable petechiae developing over the upper body, particularly in the axillae, within 24-36 hours of insult or injury. These petechiae occur in 20-50% of patients and resolve quickly, but they are virtually diagnostic in the right clinical setting. Subconjunctival and oral hemorrhages and petechiae can also appear.
Central nervous system dysfunction initially manifests as agitation or delirium but may progress to stupor, seizures, or coma and is frequently unresponsive to correction of hypoxia. Retinal hemorrhages with intra-arterial fat globules are visible upon funduscopic examination.
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