DOCSLIB.ORG

Fat Embolism Syndrome Todd Nickoles, MBA, RN, BSN Learning Objectives

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Fat Embolism Syndrome Todd Nickoles, MBA, RN, BSN Learning Objectives Fat Embolism Syndrome Todd Nickoles, MBA, RN, BSN Learning Objectives • Identify the risk factors and causes of fat embolism syndrome • Recognize the signs and symptoms of fat embolism syndrome following acute trauma • Describe major and minor diagnostic criteria • Describe the possible treatments and potential outcomes of pulmonary and cerebral fat embolism syndrome Disclosure Statement • Faculty/Presenters/Authors/Content Reviewers/Planners disclose no conflict of interest relative to this educational activity. Successful Completion • To successfully complete this course, participants must attend the entire event and complete/submit the evaluation at the end of the session. • Society of Trauma Nurses is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. What is… • Fat Embolism? • Presence of fat droplets in the systemic circulation • Mechanical and/or biochemical theories • Following fractures (>95%), primarily long bone and pelvic • Also found following bone marrow transplantation, osteomyelitis, pancreatitis, alcoholic fatty liver, liposuction, and child birth • Become systemic through shunting (pulmonary or PFO) • Fat emboli are unlike thrombus: • Temporary or partial, d/t fluidity and deformability • Fat is then hydrolyzed into free fatty acids and glycerol • Toxic to lung tissue, endothelium, initiate inflammatory cascade Theories • Mechanical • Increase in pressure within bone marrow forces marrow fat into circulation • Fractures or reaming Theories • Mechanical • Biochemical • Following injury or insult • Systemic release of free fatty acids (chylomicrons) and glycerol • Acute‐phase reactants cause chylomicrons to form globules Theories • Mechanical • Biochemical In either case: • Multiple emboli collect in pulmonary vasculature, increase PA pressure and right heart failure, respiratory symptoms • High pressure forces deformable fat globules through pulmonary shunts (PFO?), shower to head and upper body Theories • Mechanical • Biochemical In either case: • Accumulated fat globules are cytotoxic • Trigger inflammatory cascade: • Local endothelial injury • Membrane permeability & edema • Hemorrhage What is… • Fat Embolism • Fat Embolism Syndrome (FES)? • End‐organ dysfunction related to multiple fat emboli • Pulmonary –acute respiratory failure, ARDS • Cerebral – confusion, loss of consciousness, cerebral edema • Cutaneous –petechial rash upper anterior torso, axillary, conjunctiva • Presence of diagnostic criteria • Traumatic or non‐traumatic History • First description in 1861 by German pathologist Zenker • Discovered on autopsy of a farmer crushed between two wagons • First clinical diagnosis in 1873 by Von Bergmann • First in American literature in 1879 by Fenger & Salisbury • Leading causative theories developed in 1924 and 1927 • Diagnostic criteria developed in 1974 by Gurd & Wilson Epidemiology • Reported incidence (clinical criteria) during 1970’s up to 20% • Reported incidence (cc) of FES following trauma, 1‐2% • With bilateral femur fractures, 5‐7.5% • Following IM nailing, 11% • 5% of cases occur without trauma • Incidence on autopsy, 20% • Estimated mortality, 7‐20% • Assumed to be underdiagnosed Case Study #1 16 year old restrained passenger, rear middle seat, high speed MVC vs tree. 15 16 17 Case Study #1 16 year old restrained passenger, rear middle seat, high speed MVC vs tree. Prolonged extrication, VSS at scene, A&Ox3, GCS 15. Scene VS: 116/68, 112, 20, 88%, GCS15 Scene time: 1:00 Transport time: 15min High energy? Expected body system injuries? Meet activation criteria? • Occupant death, prolonged extrication, >1 long prox bone fracture, speed, intrusion • MCI –2 Level 1 (1 prehospital arrest), 1 Level 2, 1 Level 3 • + Another medical code at the same time Risk factors FES • High‐velocity trauma • Young age • Fracture‐related: • Closed fractures • Multiple fractures • Conservative fracture management • Presence of a contused lung? • Theory: increased shunting burden on healthy lung Case Study #1 16 year old restrained passenger, rear middle seat, high speed MVC vs tree. Prolonged extrication, VSS at scene, A&Ox3, GCS 15. Arrived at ED as Level 2 activation. Remained stable in ED… ED VS: 130/84, 68, 33, 100%, 36.3, GCS15 Known injuries: • Head –SDH, SAH, IPH, scalp lac • Neck –C3 and C4 TP fractures • Chest –B pulm contusions, B PTX • Abd – Contusion of transverse colon • Ext –R midshaft femur fracture, left knee lac Case Study #1 16 year old restrained passenger, rear middle seat, high speed MVC vs tree. Prolonged extrication, VSS at scene, A&Ox3, GCS 15. Arrived at ED as Level 2 activation. Remained stable in ED, admitted to PICU. ED VS: 130/84, 68, 33, 100%, 36.3, GCS15 Known injuries on admission to PICU (ED LOS >4hrs): • Head –SDH, SAH, IPH, scalp lac GCS15, PICU obs, Neurosurgery cx • Neck –C3 and C4 TP fractures Neurosurgery cx, stable with collar • Chest –B pulm contusions, small B PTX no chest tubes, sup O2 & PICU obs • Abd – Contusion of transverse colon Obs • Ext –R midshaft femur fracture, left knee lac Ortho cx, traction in PICU, plan for ORIF to follow Case Study #1 16 year old restrained passenger, rear middle seat, high speed MVC vs tree. Prolonged extrication, VSS at scene, A&Ox3, GCS 15. Arrived at ED as Level 2 activation. Remained stable in ED, admitted to PICU. Seizure upon arrival in PICU… Cerebral signs FES • **First rule out TBI • Results from emboli to brain via carotid arteries • Mechanical and biochemical effects • Symptoms vary in severity and are non‐specific (non‐ focal) • Mild –mental status changes • Moderate – decreased LOC, seizures • Severe – encephalopathy, coma • Imaging: CT normal or non‐specific, eg. edema • 16% show multiple infarcts • MRI: >95% show “starfield pattern” • Treatment: supportive, depend on severity (similar to DAI) • Airway, ventilation, seizure control • ICP, decompressive crani Case Study #1 16 year old restrained passenger, rear middle seat, high speed MVC vs tree. Prolonged extrication, VSS at scene, A&Ox3, GCS 15. Arrived at ED as Level 2 activation. Remained stable in ED, admitted to PICU. Seizure upon arrival in PICU, intubated, ICP monitor placed… Pulmonary signs FES • **First rule out other pulmonary diagnoses • Pulmonary contusions • Pulmonary edema • Thrombus pulmonary embolism • Aspiration • Pneumonia Pulmonary signs FES • **First rule out other pulmonary diagnoses • Results from emboli to pulmonary vasculature • Mechanical obstruction and biochemical effects • Respiratory distress symptoms • Drop in SpO2, PaO2, increased O2 requirements • Imaging: CXR – bilat diffuse patchy opacities “snowstorm” • CT – “ground glass” opacities, nodules • Treatment: supportive, depend on severity • Airway, ventilation –FIO2, PEEP, lung protective strategies http://orthotips.com/20‐fat‐embolism http://learningradiology.com/notes/chestnotes/fatembolism.htm High‐Resolution Ct Findings In Mild Pulmonary Fat Embolism* Malagari K, Economopoulos N, Stoupis C, et al. Chest. 2003;123(4):1196‐1201. Lindeque’s respiratory criteria Criteria • Sustained PaO2 < 8kPa (60 mmHg) • Sustained PaCO2 >7.3kPa (55 mmHg) or pH <7.3 • Sustained RR >35 bpm after adequate sedation • Increased WOB (dyspnea, accessory muscle use, tachycardia, anxiety) Lindeque et al. Fat embolism syndrome: A double blind therapeutic study. J Bone Joint Surg Br. 1987;69:128–31. Case Study #1 16 year old restrained passenger, rear middle seat, high speed MVC vs tree. Prolonged extrication, VSS at scene, A&Ox3, GCS 15. Arrived at ED as Level 2 activation. Remained stable in ED, admitted to PICU. Seizure upon arrival in PICU, intubated, ICP monitor placed, HFOV started (8 hours after intubation)… Cutaneous signs FES • “classic feature” • Non‐dependent petechial rash • Upper anterior torso • Axillary regions • Conjuctiva Gurd’s diagnostic criteria Fat Embolism Syndrome = 1 major + 4 minor Major Criteria Minor Criteria • Hypoxia (<60mmHg O2) (95%) • Pyrexia (>39 C) • Confusion (60%) • Tachycardia (>120 BPM) • Petechial rash (33%) • Retinal changes (petechiae) • Anuria or Oliguria • Anemia (Hgb drop 20%) • Thrombocytopenia (drop 50%) • High ESR (>71 mm/hr) • Fat macroglobulinemia Gurd, Wilson. The fat embolism syndrome. J Bone Jt Surg Br. (1974) 408‐416. Schonfeld’s diagnostic criteria Symptoms Points Diffuse petechiae 5 Alveolar infiltrates on chest radiograph 4 Hypoxemia (<70 mmHg) 3 Confusion 1 Fever >38 C1 Heart rate >120 BPM 1 Respiratory rate >30 BPM 1 *Five or more points required for diagnosis Schonfeld et al. Fat embolism prophylaxis with corticosteroids. Ann Int Med 99 (1983) 438‐443. Case Study #1 16 year old restrained passenger, rear middle seat, high speed MVC vs tree. Prolonged extrication, VSS at scene, A&Ox3, GCS 15. Arrived at ED as Level 2 activation. Remained stable in ED, admitted to PICU. Seizure upon arrival in PICU, intubated, ICP monitor placed, HFOV started… Fever, tachycardia, anemia, thrombocytopenia Gurd’s Criteria: Schonfelds Criteria: • 3 Major • 16 points (100%) • 4 Criteria Treatments FES • No specific treatment (yet) • Supportive therapies (previously mentioned) • Corticosteroids? • Heparin? Case Study #1 16 year old restrained passenger, rear middle seat, high speed MVC vs tree. Prolonged extrication, VSS at scene, A&Ox3, GCS 15. Arrived at ED as Level 2 activation. Remained stable in ED, admitted to PICU. Seizure upon arrival in PICU, intubated, ICP monitor placed, HFOV started, but patient continued to rapidly deteriorate. Withdrawal of support by family. Autopsy findings • Prospective
Load more

Recommended publications
  • A Young Adult with Post-Traumatic Breathlessness, Unconsciousness and Rash
    Shihan Mahmud Redwanul Huq 1, Ahmad Mursel Anam1, Nayeema Joarder1, Mohammed Momrezul Islam1, Raihan Rabbani2, Abdul Kader Shaikh3,4 [email protected] Case report A young adult with post-traumatic breathlessness, unconsciousness and rash Cite as: Huq SMR, A 23-year-old Bangladeshi male was referred to our with back slab at the previous healthcare facility. Anam AM, Joarder N, et al. hospital for gradual worsening of breathlessness During presentation at the emergency department, A young adult with post- over 3 h, developed following a road-accident he was conscious and oriented (Glasgow coma scale traumatic breathlessness, about 14 h previously. He had a close fracture of 15/15), tachycardic (heart rate 132 per min), blood unconsciousness and rash. mid-shaft of his right tibia, which was immobilised pressure 100/70 mmHg, tachypnoeic (respiratory Breathe 2019; 15: e126–e130. rate 34 per min) with oxygen saturation 89% on room air, and afebrile. Chest examination revealed a) b) restricted chest movement, hyper-resonant percussion notes and reduced breath sound on the left, and diffuse crackles on both sides. He was fit before the accident with no known medical illness. Oxygen supplementation (up to 8 L·min−1) and intravenous fluids were provided as required. Simultaneously, a portable anteroposterior radiograph of chest was performed (figure 1). Task 1 Analyse the chest radiograph. Figure 1 Chest radiography: a) anteroposterior view; b) magnified view of same image showing the clear margin of a pneumothorax on the left-hand side (dots and arrow). @ERSpublications Can you diagnose this young adult with post-traumatic breathlessness, unconsciousness and rash? http://bit.ly/2LlpkiV e126 Breathe | September 2019 | Volume 15 | No 3 https://doi.org/10.1183/20734735.0212-2019 A young adult with post-traumatic breathlessness Answer 1 a) b) The bilateral patchy opacities are likely due to pulmonary contusion or acute respiratory distress syndrome (ARDS) along with the left- sided traumatic pneumothorax.
    [Show full text]
  • Fat Embolism Syndrome
    Crit Care & Shock (2008) 11 : 83-93 Fat Embolism Syndrome Gavin M. Joynt, Thomas ST Li, Joey KM Wai, Florence HY Yap Abstract The classical syndrome of fat embolism is recognition as well as the development of preventive characterized by the triad of respiratory failure, and therapeutic strategies. Early fracture fi xation neurologic dysfunction and the presence of a is likely to reduce the incidence of fat embolism petechial rash. Fat embolism syndrome (FES) syndrome and pulmonary complications; however occurs most commonly following orthopedic the best fi xation technique remains controversial. trauma, particularly fractures of the pelvis or long The use of prophylactic corticosteroids may be bones, however non-traumatic fat embolism has considered to reduce the incidence of FES and in also been known to occur on rare occasions. Because selected high-risk trauma patients but effects on no defi nitive consensus on diagnostic criteria exist, outcome are not proved. New reaming and venting the accurate assessment of incidence, comparative techniques have potential to reduce the incidence research and outcome assessment is diffi cult. A of FES during arthroplasty. Unfortunately, no reasonable estimate of incidence in patients after specifi c therapies have been proven to be of benefi t long bone or pelvic fractures appears to be about in FES and treatment remains supportive with 3-5%. The FES therefore remains an important priority being given to the maintenance of adequate cause of morbidity and mortality and warrants oxygenation. further investigation and research to allow proper Key words: respiratory failure, petechiae, rash, trauma, orthopedic, fracture Introduction The classical syndrome of fat embolism is characterized following orthopedic trauma, particularly fractures of by the triad of respiratory failure, neurologic the pelvis or long bones, however non-traumatic fat dysfunction and the presence of a petechial rash [1,2].
    [Show full text]
  • Cerebral Fat Embolism Syndrome After Long Bone Fracture Due to Traffic Accident: a Case Report
    Chen et al. Neuroimmunol Neuroinflammation 2018;5:31 Neuroimmunology DOI: 10.20517/2347-8659.2018.23 and Neuroinflammation Case Report Open Access Cerebral fat embolism syndrome after long bone fracture due to traffic accident: a case report Xing-Yong Chen1,#, Jian-Ming Fan2,#, Ming-Feng Deng2, Ting Jiang3, Feng Luo3 1Department of Neurology, Fujian Provincial Hospital, Fujian Medical University Provincial Clinical College, Fuzhou 350001, China. 2Intensive Care Unit, Fujian Provincial Hospital Wuyi Branch Hospital, Wuyishan City Hospital, Wuyishan 354300, China. 3Department of Image Diagnoses, Fujian Provincial Hospital Wuyi Branch Hospital, Wuyishan City Hospital, Wuyishan 354300, China. #Authors contributed equally. Correspondence to: Dr. Xing-Yong Chen, Department of Neurology, Fujian Provincial Hospital, Fujian Medical University Provincial Clinical College, Fuzhou 350001, China. E-mail: [email protected]; Dr. Jian-Ming Fan, Intensive Care Unit, Fujian Provincial Hospital Wuyi Branch Hospital, Wuyishan City Hospital, Wuyishan 354300, China. E-mail: [email protected] How to cite this article: Chen XY, Fang JM, Deng MF, Jiang T, Luo F. Cerebral fat embolism syndrome after long bone fracture due to traffic accident: a case report. Neuroimmunol Neuroinflammation 2018;5:31. http://dx.doi.org/10.20517/2347-8659.2018.23 Received: 26 Apr 2018 First Decision: 11 Jun 2018 Revised: 20 Jun 2018 Accepted: 20 Jun 2018 Published: 1 Aug 2018 Science Editor: Athanassios P. Kyritsis Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang Abstract Cerebral fat embolism syndrome (CFES) is an uncommon but serious complication of long bone fracture. We reported a 19-year-old male patient who sustained CFES due to multiple limbs long bone fractures after a traffic accident injury.
    [Show full text]
  • Fracture Complications.Pdf
    Musculoskeletal Trauma 1 Fracture Complications Tim Coughlin “A fracture is a soft tissue injury, complicated by a broken fracture as soon as possible. Remember though that the bone”. is is an important concept to remember when condition is rare and other differential diagnoses such a thinking about the potential complications, as many will be pulmonary embolism must be considered. related to soft tissue rather than bony injury. is chapter will be broken down into two sections; Muscle Damage and Rhabdomyolysis general complications and fracture specific complications. Rhabdomyolysis is a condition which occurs when skeletal muscle is rapidly broken down releasing myoglobin into the circulation. is is seen in patients who have suffered a crush General Complications injury and those who have been immobilised on the floor for a significant time period causing a pressure injury. A typical General complications refer to the things you must have in example would be an intoxicated patient who has fallen and your mind when you assess any patient with a fracture. remained on the floor overnight or an elderly patient with a Orthopaedic surgeons are often accused of treating the bone, neck of femur fracture who is unable to get up. the whole bone and nothing but the bone. I would like to think e release of myoglobin can cause acute renal failure to this is not true! ese are the things you should consider develop. e patient will also have local pain in the affected initially when assessing a patient: area and in severe cases compartment syndrome (see below) or pressure sores may develop.
    [Show full text]
  • Genesis of Fat Emboli J Clin Pathol: First Published As 10.1136/Jcp.S3-4.1.132 on 1 January 1970
    J. clin. Path., 23, Suppl. (Roy. Coll. Path.), 4, 132-142 Genesis of fat emboli J Clin Pathol: first published as 10.1136/jcp.s3-4.1.132 on 1 January 1970. Downloaded from A. J. WATSON University ofNewcastle upon Tyne In pathological terms fat embolism may be Some may be stuck fast, but there is evidence defined as the blockage of blood vessels by liquid that others continue to flow slowly through the fat globules. As Szabo (1970) emphasizes, on small vessels and recirculate, returning eventually page 123 of this issue, a clear distinction must be to the lungs (Scriba, 1880; Scuderi, 1953; Moser drawn between the histopathological findings and Wurnig, 1954). When the lungs are heavily and the much less common clinical syndromes of embolized, the globules passing through the fat embolism. Fat emboli in the lungs have been lung vessels into the systemic circulation may reported in a great variety of associations, but by become very numerous. Possibly this is the mostcopyright. far the most common and the most important serious consequence because of the multifocal association is with major fractures and accom- brain damage which results from cerebral panying soft tissue damage due to severe trauma. embolization (Scriba, 1880; Sevitt, 1962) and Controversy exists regarding the clinical signi- may in turn lead to secondary lung changes. But ficance of the emboli and there is even a sugges- some would give pride of place to the pulmonary tion that they are not essential for the changes changes and regard the cerebral damage as underlying the 'fat-embolism' syndrome.
    [Show full text]
  • Incidence of Fat Embolism Syndrome in Femur Fractures and Its Associated Risk Factors Over Time—A Systematic Review
    Journal of Clinical Medicine Review Incidence of Fat Embolism Syndrome in Femur Fractures and Its Associated Risk Factors over Time—A Systematic Review Maximilian Lempert 1,* , Sascha Halvachizadeh 1 , Prasad Ellanti 2, Roman Pfeifer 1, Jakob Hax 1, Kai O. Jensen 1 and Hans-Christoph Pape 1 1 Department of Trauma, University Hospital Zurich, Raemistr. 100, 8091 Zürich, Switzerland; [email protected] (S.H.); [email protected] (R.P.); [email protected] (J.H.); [email protected] (K.O.J.); [email protected] (H.-C.P.) 2 Department of Trauma and Orthopedics, St. James’s Hospital, Dublin-8, Ireland; [email protected] * Correspondence: [email protected]; Tel.: +41-44-255-27-55 Abstract: Background: Fat embolism (FE) continues to be mentioned as a substantial complication following acute femur fractures. The aim of this systematic review was to test the hypotheses that the incidence of fat embolism syndrome (FES) has decreased since its description and that specific injury patterns predispose to its development. Materials and Methods: Data Sources: MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases were searched for articles from 1 January 1960 to 31 December 2019. Study Selection: Original articles that provide information on the rate of FES, associated femoral injury patterns, and therapeutic and diagnostic recommendations were included. Data Extraction: Two authors independently extracted data using a predesigned form. Statistics: Three different periods were separated based on the diagnostic and treatment changes: Group 1: 1 January 1960–12 December 1979, Group 2: 1 January 1980–1 December 1999, and Group 3: 1 January 2000–31 December 2019, chi-square test, χ2 test for group comparisons of categorical Citation: Lempert, M.; p n Halvachizadeh, S.; Ellanti, P.; Pfeifer, variables, -value < 0.05.
    [Show full text]
  • Orthopedic Emergencies- Long Bone Fractures, Michael Miranda, MD
    CCSU Sports Medicine Symposium Tuesday, March 5, 2019 Orthopedic Emergencies- LONG BONE FRACTURES Michael Miranda MD FAAOS Director of Orthopedic Trauma BJI/ Hartford Hospital No Conflict I have no commercial conflicts with this presentation. Kevin Ware CCSU SPORTS SYMPOSIUM 2019 March 5 2019 4 CCSU Sports Medicine Symposium Tuesday, March 5, 2019 Long bone fractures are attention getters… Confidential and Proprietary Information February 26, 2019 5 Long bone fractures relatively rare in Sport- • Important to recognize the issues that can prolong recovery CCSU SPORTS SYMPOSIUM 2019 March 5 2019 6 Agenda- 30 min •Discuss long bone fractures and identify potential complications that may occur •Understand the prognosis of long bone fractures •Recommendations for return to participation for long bone fractures CCSU SPORTS SYMPOSIUM 2019 March 5 2019 7 CCSU Sports Medicine Symposium Tuesday, March 5, 2019 Agenda • Discuss fractures and what would make them possible emergencies • Discuss the major long bone fractures cases and relevance to sport • Review their prognosis and return to sport potential/timing CCSU SPORTS SYMPOSIUM 2019 March 5 2019 8 Implications of long bone fractures WHY ARE LONG BONE FRACTURES EMERGENCIES? • Blood Loss • Neurovascular damage • Fat embolism • Long term loss of function Confidential and Proprietary Information February 26, 2019 10 CCSU Sports Medicine Symposium Tuesday, March 5, 2019 Physiologic events after long bone fractures and injuries • Local • Sytemic – Immediate – Immediate – Early – early – delayed Immediate Potentail Complications • Systemic immediate Complication • Local immediate complication – hypovolemic shock – Injury to major vessels. – -Injury to muscles and tendons. – -Injury to joints. – -Injury to nerves. Early Potential Complications Local Systemic • Bleeding /shock • Hypovolemic shock • Compartment syndrome.
    [Show full text]
  • Fat Embolism
    Fat Embolism P. GLOVER, L. I. G. WORTHLEY Department of Critical Care Medicine, Flinders Medical Centre, Adelaide SOUTH AUSTRALIA ABSTRACT Objective: To review the pathophysiology and management of patients with clinical manifestations of fat embolism. Data sources: A review of studies reported from 1976 to 1998 and identified through a MEDLINE search of the literature on fat embolism and fat embolism syndrome. Summary of review: Fat embolism occurs when bony or soft tissue trauma has caused fat to enter the circulation, or in atraumatic disorders where circulating fat particles have coalesced abnormally within the circulation. The fat particles deposit in the pulmonary and systemic circulations, although only 1 - 2% develop a clinical disorder with respiratory, cerebral and dermal manifestations known as the fat embolism syndrome. Rarely, fat embolism produces a fulminant fat embolism syndrome due to mechanical obstruction within the pulmonary circulation causing a severe right heart failure. The fat embolism syndrome is believed to be caused by the toxic effects of free fatty acids liberated at the endothelial layer which cause capillary disruption, perivascular haemorrhage and oedema. The clinical manifestations of respiratory failure, petechiae and a diffuse or focal cerebral disturbance, are characteristic but not pathognomonic of the syndrome. The syndrome is largely self limiting with treatment being symptomatic. Therapy is directed at maintaining respiratory function and largely follows the same principles of management used in patients who have the acute respiratory distress syndrome. Early immobilization of fractures and methods to reduce the intramedullary pressure during total hip arthroplasty have reduced the incidence of operative fat embolisation. Corticosteroids either before or after the development of respiratory or cerebral symptoms have not been shown to be of any benefit.
    [Show full text]
  • General Principles of Orthopedic Injuries Episode Overview
    Crack Cast Show Notes – General Principles of Orthopedic Injuries – November 2016 www.crackcast.org Chapter 49 – General Principles of Orthopedic Injuries Episode Overview 1. List 10 complications of fractures 2. Describe the classification system for open fractures a. Describe the management goals in open fracture 3. Link the nerve injury expected with the following orthopedic injuries: a. Distal radius b. Elbow c. shoulder dislocation d. Sacral e. Acetabulum fracture f. hip fracture. g. femoral shaft fracture h. knee dislocation i. lateral tibial plateau fracture 4. List 10 causes of compartment syndrome 5. List 7 physical findings in compartment syndrome 6. Describe the management of compartment syndrome 7. List 5 bones predisposed to AVN 8. Describe diagnostic criteria for CRPS 9. List 6 complications of prolonged immobility Wise Cracks 1. Describe fat embolism syndrome and its management 2. What is the most common site of compartment syndrome? 3. Are open or closed fractures at higher risk of compartment syndrome? 4. Please differentiate between sprain, strain and bursitis 5. Please differentiate between tendonitis and tendonosis? --------- Rosen’s in Perspective Management principles ● Reasons for urgent orthopedic consultation: ○ Long bone #s ○ Open fractures ○ Fractures or injuries violating joints ○ Neurovascular compromise ● See Table 49-1 for a list of >40 fracture eponyms ● Principles ○ Get key information from patient re: age, mechanism of injury, chief complaint, medical Hx ○ Do a physical exam to predict the injury and what
    [Show full text]
  • Fat Embolism Syndrome with Cerebral Fat Embolism Associated with Long-Bone Fracture
    A Case Report & Literature Review Fat Embolism Syndrome With Cerebral Fat Embolism Associated With Long-Bone Fracture Steven F. DeFroda, MD, ME, and Stephen A. Klinge, MD with one study finding an average of 48.5 hours Abstract after injury and an incidence of 0.15% to 2.4%.4 Fat embolism syndrome (FES) is a well- The overall FES rate is <1% in retrospective known sequela of long-bone fracture and reviews and 11% to 29% in prospective studies.5 fixation. FES most commonly affects the FES may present without one or all of the Gurd pulmonary system. Brain emboli may and Wilson criteria,6 and cerebral fat embolism lead to a symptomatic cerebral fat embo- (CFE) can be even more difficult to diagnose. Pa- lism (CFE), which is devastating. tients with CFE typically present with a wide array In this article, we review the presen- of postoperative neurologic deficits, commonly in tation, causes, and management of FES the 24- to 72-hour window in which FES typically presenting with CFE, report a case, and occurs. Correct diagnosis and management of review the literature. CFE require a high index of suspicion and knowl- The case involved an otherwise healthy edge of the diagnostic work-up. In the postop- 42-year-old woman who developed CFE erative setting, it can be difficult to distinguish after reamed intramedullary nail fixa- CFE-related neurologic deficits from the normal tion of femoral and tibial shaft fractures sequelae of anesthesia, pain medications, and other factors. during a single operation. When the In this article, we report the case of a 42-year-old patient presented after surgery, she was woman who developed CFE after reamed intra- nonverbal and was having diffuse extrem- medullary nail fixation of femoral and tibial shaft ity weakness.
    [Show full text]
  • Fat Embolism Syndrome and Crush Syndrome
    The Journal of Maharashtra Orthopaedic Association September / December - 2006 Fat Embolism Syndrome And Crush Syndrome Dr. Shivaprasad D. Khot M.S. Orth., D. Orth. ( Mumbai) Dr. Rahul S. Khot M.B.B.S., D. Orth., D.N.B. v Introduction v v Causes v Fat Embolism syndrome is a major cause of FES occurs most commonly as an early morbidity and mortality after multiple long bone complication of fractures of the pelvis and long fractures and is an important cause of ARDS. bones. FES is also reported in other entities: FES may be defined as, “a complex alteration l As a complication of reaming of medullary of homeostasis that occurs as an infrequent canals of long bones complication of fractures of long bones and pelvis l As a complication of reaming and cementation and manifests clinically as acute respiratory during joint replacement ? Massive soft tissue insufficiency”. injury ? Severe burns FES develops when fat emboli become l Liposuction impacted in pulmonary microcirculation and other l Chronic osteomyelitis microvascular beds such as the brain and is l Metabolic disorders characterized by respiratory failure, cerebral l dysfunction and petechiae. In-patients with pre Neoplasms existing pulmonary disease the addition of FES can l Renal transplant be life threatening. FES is an a important cause of l Bone infarcts in hemoglobinopathoies acute respiratory distress syndrome. With prompt l Collagen disease recognition, the treatment of the fat embolism l syndrome has become more specific and less empiric, Diabetes resulting in decrease morbidity and mortality. In l Severe infection recent years prevention of fat embolism syndrome l Inhalation anesthesia by early fracture fixation and patient mobilization l Blood transfusion has become the focus of a wave of clinical v Historical Aspects v investigation.
    [Show full text]
  • The Syndrome of Fat Embolism and Its Origin J Clin Pathol: First Published As 10.1136/Jcp.S3-4.1.123 on 1 January 1970
    J. clin. Path., 23, Suppl. (Roy. Coll. Path.), 4, 123-131 The syndrome of fat embolism and its origin J Clin Pathol: first published as 10.1136/jcp.s3-4.1.123 on 1 January 1970. Downloaded from GYORGY SZABO From the National Institute of Traumatology, Budapest, Hungary The solution of the now century-old riddle of fat embolism where, depending on the criteria fat embolism has been much delayed by a of diagnosis, its frequency is said to range misunderstanding which is reflected even in between 5% and nearly 100% (Evarts, 1965). terminology. A study of the incidence and severity of fat In patients who die shortly after injury embolism at necropsy among injured and microscopic droplets of fat are found obstructing uninjured cases was therefore undertaken. small vessels, particularly in the lungs but also copyright. sometimes in other organs. Lung embolism is found in nearly all patients when injury includes a fracture of a long bone. On the other hand, Fat Embolism at Necropsy a well defined clinical syndrome is observed only in certain patients with bone fractures. The The grading of fat emboli proposed by Sevitt syndrome is characterized by severe pulmonary, (1962) was adopted. One hundred posttraumatic circulatory, and neurological signs and symptoms and 100 non-traumatic cases were studied. http://jcp.bmj.com/ which lead to death in a high percentage of cases. Forty-one of the injured patients with fractures A distinction must be made between the patho- died within a week of the accident: fat emboli logical entity of fat emboli in small vessels of were found in the lungs in every case, the average those who die after bone injury and the clinical number of emboli being 1,017 ± 259 per mm3 syndrome.
    [Show full text]