resources_fat embolism syndrome (fes).ppt
TRANSCRIPT
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Some defnitions
Fat Emboli: Fat particles or dropletsthat travel through the circulation
Fat Embolism: A process by which
at emboli passes into thebloodstream and lodges within ablood vessel.
Fat Embolism Syndrome (FES):serious maniestation o atembolism occasionally causesmulti system dysunction, thelungs are always involved and nextis brain
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auses o F!S
BluntTrauma
"ong bone#Femur,
tibia,pelvic$actures
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auses o F!S Non Trauma: agglutination o chylomicrons and
%"&" by high levels o plasma '(.
disease)related &iabetes, acute pancreatitis, burns, S"!, sic*le cell
crisis
drug)related parenteral lipid inusion
procedure)related +rthopedic surgery, liposuction
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(athophysiology o F!S
!xact mechanism un*nown, but two mainhypothesis
.-echanical ypothesis
/.0iochemical ypothesis
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-echanical ypothesisObstruction of vessels and capillaries
1ncrease in intermedullary pressure orces at and marrow intobloodstream
0one marrow contents enter the venous system and lodge inthelungs as emboli
Smaller at droplets may travel through the pulmonary
capillaries into the systemic
circulation: !mboli2ation tocerebral vessels or renal vessels also leads to central nervoussystem and renal dysunction
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0iochemical ypothesis
Toxicity of free fatty acids
circulating ree atty acids directly a3ectthepneumocytes, producing abnormalities in gasexchange
oexisting shoc*, hypovolemia and sepsisimpair liver unction and augment toxic e3ectso ree atty acids
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linical -aniestationsAsymptomatic or the frst /)45 hours
Pulmonary ysfunction 'espiratory Failure and A'&S #tachypnea, dyspnea, crac*les,
cyanosis$ ypoxemia systemic arterial hypotension, a decrease in cardiac output,
and arrhythmias
Neurolo!ical (nonspeci"c) acute conusion, headache, stupor, coma, rigidity or
convulsions
ermatolo!ical Si!ns A reddish brown petechial rash within /4)67 hours distributed to the upper body, chest, nec*, upper arm,
axilla, shoulder, oral mucous membranes andcon8unctivae
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linical -aniestation
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&iagnosislinical examination preerred over diagnostic
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"aboratory Studies
#rterial Blood $ases (#B$s)
%rine and sputum examination
&aemotolo!ical Tests
Bioc'emical tests
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1magining
hest x)ray shows multiple 9occulent shadows #snow stormappearance$. picture may be complicated by inectionor pulmonary edema.
Scan brain may be normal or may reveal di3use white)matter
petechial haemorrhages
elical Scan chest may be normal as the at droplets are lodged in
capillary beds. an detect lung contusion, acute lungin8ury, or A'&S may be evident.
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hest ;)rayE admitA( < expiratory flm so we cannotcomment on cardiac shadow.owever, there is no evidence olung contusion, pneumo, haemo orpneumohaemothorax.
S*% admit (+,'ours later)upper lobe diversionand bilateralpulmonary infltrates
Alta ussain: =A Fatal Fat !mbolism-. he 1nternet >ournal o Anesthesiology, /??4. %ol
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-'1 showing oci o
ischemia suggestive o atembolism syndrome
post operative day+/ and shows evolvingcortical inarctions
post operativeday , showingmultiplehyperintense areasconsistent with
multiple emboli
Source:http:www.ispub.com8ournaltheBinternetB8ournalBoBanesthesiologyvolumeBCBnumberB/articleacuteBatalBatBembolismBsyndromeBinBbilateralBtotalB*neeBarthroplastyBaBreviewBoBtheB
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reatment
Prop'ylaxis 1mmobili2ation and early internal fxation o ractureigh doses o corticosteroids
0edicalSel limiting disease. Support treatment or cardiovascular
and respiratory issues
-aintenance o intravascular volume
#lbuminis recommended
AdeDuate analgesiaeparin
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'is* Factors
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(rognosis-ost death contributed to pulmonary
dysunction
ard to determine exact mortality rate
!stimated less than ?E
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ouse -.& lipPulmonary ysfunction'espiratory Failure and A'&S #tachypnea,
dyspnea, crac*les, cyanosis$
ypoxemia
systemic arterial hypotension, a decrease in
cardiac output, and arrhythmias
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Sources
Alta ussain: =A Fatal Fat !mbolism-. he 1nternet >ournal o Anesthesiology,/??4. %olume 5 @umber /.
Fabian . =nraveling the at embolism syndromeG. @ !ngl > -ed
CC6H6/C:C7I76
. Jalway, >. !. et2la3 < '. eland : =Acute Fatal Fat !mbolism Syndrome 1n0ilateral otal Knee Arthroplasty I A 'eview + he Fat !mbolismSyndromeG. he 1nternet >ournal o Anesthesiology. /??C %olume C@umber /
"ati, A., 0ashir, A., Aurang2eb. LFat !mbolism and Fat !mbolism SyndromeH-anagement rends.L (roessional -ed > M.4 #/??5$: 4?N)46.