Fat emboli syndrome

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My understanding is that it is due to activation of or creation of oxygen free radicals
Rw

Sent from my iPhone so I can reply quickly so please forgive any errors

On Jun 7, 2011, at 11:02 AM, "McSwain, Norman E" <nmcswai at tulane.edu> wrote:

> Several years ago, I look up the fat emboli syndrome literature. I could
> find no research that used Koch's postulates (or a similar thought
> process) to prove that the syndrome was due to actual fat emboli. Even
> the IV administration of fat particles did not produce 'fat emboli". 
> 
> Yes, the syndrome probably exists but nothing that is caused by fat. Is
> this an 'urban myth'?  Is there any scientific basis for the
> relationship except that it occurs after long bone fractures 
> 
> 
> Norman
> Norman McSwain MD, FACS
> Professor, Tulane School of Medicine
> President, Orleans Parish Medical Society
> Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO 
> norman.mcswain at tulane.edu
> 504 988 5111
> 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Dr Timothy
> Hardcastle
> Sent: Tuesday, June 07, 2011 1:17 AM
> To: Trauma-List [TRAUMA.ORG]
> Subject: Re: Fat emboli syndrome
> 
> T Shepherd
> 
> Like this - twice, have treated about 15 Fat Embolism syndromes - most
> likely shoudl have had staged femur nailing and delay to after day 5
> (JBJS
> Am article 2009.
> 
> I wrote up a similar case in Injury Extra some three years ago: Ahmed N,
> Fouldien A, Fourie C, Hardcastle TC. Early onset Fat Embolism Syndrome:
> Case Report and Literature Review. Inj Extra 2008; 39: 305 - 308 
> http://dx.doi.org/10.1016/j.injury.2008.03.013
> 
> Maybe reading the literature discussion will reassure you regarding the
> outcome. Our patient survived with severe neurological sequelae, and the
> one we had recently here at IALCH had persistant generalised muscle
> weakness post recovery.
> 
> Regards
> Tim
> Dr T C Hardcastle
> M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
> Principal Specialist Trauma Surgeon /
> Honorary Senior Lecturer UKZN Dept Surgery
> Deputy Director - IALCH Trauma Service
> Durban, South Africa
>> 
>> 18 y/o male s/p motorcycle accident with resultant bilateral femur
>> fx and nondisplaced inferior pubic rami fracture. ORIF of femurs
> within
>> 24hr.
>> Developed ALOC worked up with head CT and MRI . Head CT was negative.
> MRI
>> identified multiple hyperdense lesions  on T2  images. Skin showed no
>> petechiae, however petechiae were present on the eye exam. The patient
>> demonstrated a rapid decline in respiratory status requiring
> intubation.
>> Progressive hypoxemia led to the use of APRV and ultimately prone
>> positioning.
>> Along with the decline in the respiratory status the patient's
> biochemical
>> profile showed an unexplained anemia, a severe thrombocytopenia and
>> progressive
>> hepatic dysfuction. Despite maximal supportive efforts the patient
> expired
>> six
>> days post-op.
>> 
>> I have treated fat emboli sydrome twice before this case. Both cases
> had
>> significant pulmonary dysfunction but nothing this serious. I kinow
> there
>> is an
>> associated 5-20% mortality but certainly did not expect it in this
> case.
>> 
>> Has anyone seen a similar course of events?
>> Other than symptomatic treatment and the questionable use of steroids
> or
>> IV
>> albumin does anyone know of any treatment options?
>> 
>> //TS
> 
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