Fat Embolism Syndrome Case Studies

Introduction
Fat embolism is fat within the circulation, which can produce embolic phenomena, with or without clinical sequelae.Fat Embolism Syndrome (FES) is fat in the circulation associated with an identifiable clinical pattern of symptoms and signs.
Majority of cases of fat embolism (95%) occur after major trauma1. It can be demonstrated in 90% of patients with long bone fractures, out of which only 1-5% of patients develop fat embolism syndrome (FES).
FES is a serious consequence of fat embolism. Its overall mortality rate generally varies between 5-15% of which a majority dies of respiratory complications2. FES is self-limiting, provided that supportive therapy is maintained.

Abstract
A 22 year old male was admitted to the Intensive

The patient was kept in the propped up position with the head end elevated to 450.
2. He was initially given 60% oxygen via a venturi mask
3. His vital parameters were monitored
ECG, Heart rate ,SPO2, NIBP, Hourly urine output, temperature, GCS score
4. His initial arterial blood gas with 60% oxygen was pH-7.39 pO2-385 mm Hg pCO2-32 mm Hg
BE(Blood)- +1.2
HCO3 std20 meq/L
5. A nasogastric tube was inserted as his GCS was low for the purpose of giving medication and starting nasogastric feeds.
6. He was started on intravenous fluids according to his maintenance requirement.
7. Analgesia was provided by a regular dose of oral paracetamol 1g 6 hourly
8. Intravenous antibiotics were continued which were started in the ward
Cefuroxime 750 mg 8 hourly
Flagyl 500mg 8 hourly
9. Antacid prophylaxis with intravenous ranitidine 50mg 12 hourly
10. Nebulisation with normal saline 6hourly combined with chest and limb physiotherapy

Subsequent management
The supportive care initiated on the day of admission was continued throughout the ICU stay. He was transfused with 1 unit of packed red cells as his haemoglobin dropped to 7.2g/dl. We didn’t transfuse him platelets although his platelet count dropped to 107,000 as there were no significant bleeding