RT Book, Section
A1 Keneally, Ryan J.
A2 Freeman, Brian S.
A2 Berger, Jeffrey S.
SR Print(0)
ID 1135743555
T1 Anesthesia for Orthopedic Surgery
T2 Anesthesiology Core Review: Part Two Advanced Exam
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 9781259641770
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1135743555
RD 2024/04/20
AB Long  bone  fractures  predispose  patients  to  the  embolization  of  contents  of  the  medullary  region  of  bones.  Fat  emboli  are  nearly  universal  after  pelvic  or  femur  fractures  but  the  incidence  of  fat  emboli  syndrome  (FES)  is  3%–4%  with  10%–20%  mortality.  The  embolic  load  increases  as  the  space  the  medulla  is  drilled  or  around  the  time  of  the  application  of  cement  into  the  medullary  canal.  Earlier  repair  of  fractures  lowers  the  risk  for  FES.  FES  is  manifested  by  hypoxia,  mental  status  changes,  and  petechiae.  The  petechiae  are  present  on  the  conjunctiva,  oral  mucosa,  and/or  in  the  cervical  and  axillary  regions.  Transesophageal  echocardiography  can  detect  echogenic  material  which  may  be  fat  emboli  but  the  clinical  presentation  of  FES  is  delayed  and  thought  to  be  the  result  of  an  inflammatory  response.  FES  presents  between  several  hours  to  72  hours  after  the  initial  fracture.  The  symptoms  can  last  up  to  a  week  and  the  treatment  is  supportive  care  and  monitoring  for  progression  to  disseminated  intravascular  coagulation  and  multiple  organ  dysfunction.