Beruflich Dokumente
Kultur Dokumente
DR RAMESH VARADHARAJAN
Presentation
29/M
Alleged history of RTA -24th may
Head injury and tibial fracture
GCS -13/15 Pupils BERL
No other comorbities
Effort tolerance prior to RTA - Good
CT BRAIN
Diffuse cerebral edema
Thin temporal SDH Right side
Ventricles in midline
Tibialfracture
face mask
Antibiotics/anti edema measures
Splint applied
afebrile
Vitals stable
Spo2 -85-88% room air , and 97-99% with
oxygen
RR- 30-35/m , mild distress
Blood investigations-wnl ,viral markers
negative
Pt was willing for regional anesthesia
Npo and IVF advised accordingly
In O R
Procedure done under single dose SAB
Post op in ICU
Evaluated with doppler legs and
CECT thorax
Snow storm opacities b/l lung fields
Pulmonary artery showed no filling
defects
FAT EM BO LISM
Literature search
Intro-Fat Em bolism
fat globules in the peripheral
circulation and lung parenchyma
fracture of long bones, pelvis or
other major trauma.
It occurs in approximately all/most
patients( >95%) who sustain a
long bone or a pelvic fracture
phenomenon
rare complication occurring in 0.5 to 2%
of patients following a long bone fracture
Toxic effects of free fatty acids
Triad
Dyspnoea (95%)
Petechiae (33%)
Mental confusion ( 60%)
H istory
Purtscher-like retinopathy
femur
Pathogenesis
Mechanical theory
Fat globules
Biochemical theory
FFA
Coagulation theory
Thromboplastin
Complement /leucocyte activation
TREATM EN T-supportive
Maintain hemodynamics,
blood products
hydration
prophylaxis of deep venous
Ventilation strategies
Spontaneous ventilation
CPAP NIV
Invasive mechanical ventilation-
PEEP
Surgicalstrategies
Early immobilisation
Operative correction
Limit increase in intraosseous
pressure during sx
Venting hole
cementless fixation of prostheses
unreamed intramedullary femoral
shaft stabilization
Prophylaxis
Albumin
Binds FFA
Limits lung injury
Steroids
Methyprednisolone 7.5mg/kg q8h
For high risk patients
No change in mortality
Good day