Sisipan Rohani: Fat Embolism Syndrome

Ape yg Kita tau pasal Fat Embolism Syndrome? It is a clinical manifestation that developed after trauma, especially after long bone #, whereby fat droplets act as emboli becoming impacted the pulmonary circulation & other microvascular beds, thus leads to respiratory problems, or in worse condition, cerebral dysfunction. Senang paham, FES adalah keadaan dimana fat emboli menyumbat salur darah; jika ia tersumbat di microvascular beds, patient akan ada petechiae. kalo tersumbat di paru2, akan ada respiratory problem. jika tersumbat di otak, maka akan ada cerebral dysfunction. Harus ingat, FES ialah Orthopaedic Emergencies!!

Etiologies?
1. long bone # (90% of cases cause FES)
2. massive STI
3. severe burn
4. Surgical instumentation of long bones
5. non-trauma: fatty liver, prolonged corticosteroid therapy, OM, collagen disease, etc

Gurd's criteria for Diagnosis: at least 1 major + 4 minor

Major criteria
1. axillary/subconjunctiva petechiae
2. hypoxaemia (PaO2 < 60mmHg)
3. CNS depression
4. occur transiently (4-6 hours)

Minor criteria
1. tachycardia ( > 110b/min)
2. pyrexia ( > 38.5)
3. emboli present in retina on funduscopic examination
4. fat present in urine
5. sudden unexplainable drop of hematocrit or platelet value
6. inccreased ESR rate
7. fat globules present in sputum

Miscelaneous criteria
1.occurs within 72 hours of skeletal trauma
2. SOB
3. Altered mental status
4. urinary incontinence

Clinical Presentation?
1. Cardiopulmonary
- tachycardia
- tachypnoea, dyspnea & hypoxic
- fever > 38.5
- vague chest pain

2. Dermatology
- chest/axilla/subconjunctival petechiae

3. Neurology
- CNS depression /  altered mental status
- retinal hemorrhages with intra-fat globules

Investigations?
1. ABG - check PaO2
2. FBC - check hematocrit, platelet, fibrinogen
3. Urine studies - urinary aft stains
4. Chest X-ray - "snowstorm" appearance

Management?
1. Oxygenation & ventilation, monitor PaO2
2. stablilize haemodynamic status
3. hydration - fluid replacement
4. early stabilization of long bone #
5. IV corticosteroid & heparin (to reduce pulmonary oedema & intravascular clotting)

Harap ia membantu. Sumber dari Apley's concise dan juga Basic # Mx for students & Housemen. untuk pemahaman lebih mendalam, sila buat bacaan sendiri. Jika ada sebarang kemusykilan, boleh bertanyakan kepada specialist (^_^)