A 40-year-old man, was admitted with FRACTURE shaft femur following a road traffic accident. On 2nd day he became disoriented. He was found to be tachypnoeic, and had conjunctival petechiae. Most likely diagnosis is
Pulmonary embolism
Sepsis syndrome
Fat embolism
Haemothorax
(C) Fat embolism # Fat embolism & ARDS:* Fracture through a large marrowfilled cavity almost inevitably results in small showers of fat emboli being swept to the lungs.* This can usually be accommodated without serious consequences, but in some cases (and especially in those with multiple injuries & severe shock, or in patients with associated chest injuries) it results in progressive respiratory distress and multi-organ failure.* Blood gases should be measured soon after admission, and any suspicious signs such as shortness of breath, restlessness or a rise in temperature or pulse rate should prompt a search for petechial haemorrhages over the upper body, axillae and conjunct vae.* Treatment is supportive, with the emphasis on preventing hypoxia and maintaining blood volume.
Miscellaneous