Friday, January 22, 2016

Fat Embolism Syndrome (FES)

emDocs - January 21, 2016 - Authors: Tolins M and Johnson N
Edited by: Koyfman A and  Alerhand S
Key points
  • FES is a clinical diagnosis; it should be suspected in the long bone fracture patient with respiratory symptoms, altered level of consciousness, or petechial rash.
  • It can occur within hours of trauma, and while manipulation or operative management increase risk, FES can occur in the absence of any intervention.
  • Gurd’s criteria are the most frequently used clinical criteria for diagnosis; major criteria include petechial rash, respiratory signs/compactos, and CNS signs/symptoms.
  • Adjunct diagnostics include fundoscopy with Purtscher-like retinopathy, chest radiograph or CT chest with ground-glass or diffuse opacities, MRI with diffusion-weighted imaging with “starfield” pattern, and transcranial Doppler with numerous microemboli.
  • Treatment is largely supportive, and might include respiratory support, volume resuscitation, and fracture management, with close monitoring for increased ICP.
  • Unlike other stroke patients, those with FES may make dramatic improvements despite poor initial neurologic status.