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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.