Fat embolism: prognosis and symptoms

Fat embolism is a condition characterized by the presence of emboli, fat obstructions in the bronchial trees of the lungs, turning this into the fat embolism syndrome when it manages to obstruct not only the peripheral and minor ducts of the bronchi but also the main routes .

It is identified as its main cause accidents where bone fractures occur , especially bones such as the femur or multiple fractures. In these situations, this rupture manages to violate the blood vessels, allowing different elements of the body, including adipose tissue, to enter the blood, thus causing these obstructions.

Other common causes of a fat embolism are:

• Nail insertion, osteotomies and prostheses.
• Orthopedic and aesthetic surgeries.
• Marrow transplant.
• Kidney or other organ transplant.
• Injection of oily substances into blood or massive transfusions.
• Osteomielitis.
• Pancreatitis.
• Burns.

The signs and symptoms of a fat embolism can vary in its severity, being frequent that during the first 2 to 3 days it is asymptomatic. The first symptoms to appear gradually are:

• Rash or petechial eruption : very small lesions caused by the rupture of blood capillaries, that is, evidence of the leakage of blood (extravasation of red blood cells). It can occur not only in the extremities, but also in the armpits and eyes (subconjunctival).
• Mild to moderate breathing difficulties such as tachypnea or hypoxia.

At a neurological and behavioral level , it may begin to present:

• Confusion
• Dizziness
• Inability to maintain attention
• Disorientation

There is also a fulminant form of fat embolism, where cardiorespiratory arrest and / or severe systemic collapse occur. This type of case is very rare, close to 1% of fat embolism.

After this first period of “silent” embolism, the picture can worsen until presenting a great variety of symptoms in co-dependence on the cause and severity of the syndrome and the previous dispositions of the patient’s health:

• The petechial rash can turn purple: the colorations are now purple and then yellow or green due to the death and breakdown of red blood cells.
• They not only increase but can be found concentrated in regions such as the neck and armpits.
• Tachycardia and cardiac arrhythmias and increase the chances of cardiac arrest .
• Cardiovascular hypotension.
• Respiratory failure and pulmonary hypertension.
• Constant fever .
• Increased petechiae in the eyes and possible damage to the retina and vision.
• More frequent apathy, depression and seizures.

Neurological signs and symptoms of fat embolism produced by gradual hypoxia and ischemia of brain and nerve cells. Some of those that are presented are:

• Aphasia
• Apraxia
• Delusions
• Seizures
• Toilet training problems
• Persistent headache
• Hemiplejias
• Tetraplejias

The main criterion for the diagnosis of fat embolism is the presence of petechiae , and is complemented through the following clinical resources:

• Blood test : presence of fat, reduction of platelets and hematocrits. Hypoxemia : reduction of oxygen in the blood.
• Urinalysis : if there is fat in it.
• Blood pressure : if the heart rate is greater than 110 beats per minute at rest.
• Chest or head CT scan .
• Brain MRI : find or rule out cerebral infarcts and edema.
• Sputum analysis.

Some of the above tests are not only diagnostic but also prognostic. The person may or may not be left with sequelae of fat embolism to the extent that cerebral and pulmonary edema , capillary, vascular and / or cardiac damage have been found or not due to overexertion of the latter. Other aspects to take into account in order to evaluate the possible sequelae are the following:

• Treatment and prompt fixation of fractures (first 24 hours) are other determining factors for a good prognosis.
• Damages such as those produced at the retinal and vascular level are reversible after 2 to 3 weeks.
• Neurological damage also has a good reversibility prognosis.

This article is merely informative, at FastlyHeal .com we do not have the power to prescribe medical treatments or make any type of diagnosis. We invite you to see a doctor in the case of presenting any type of condition or discomfort.

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