True about fat embolism-
Correct Answer: Fat globule in urine
Description: Gurd and Wilson's criteria Major criteria Axillary or subconjunctival petechiae Hypoxaemia PaO2 <60 mm Hg, FIO2 = 0.4 Central nervous system depression dispropoionate to hypoxaemia Pulmonary oedema Minor criteria Tachycardia more than 110 beats per minute Pyrexia more than 38.5 degC Fat globules present in urine Changes in renal function (reduced urine output) Drop in haemoglobin values (more than 20% of the value upon admission) Drop in haematocrit values Drop in platelet values (more than 50% of the value upon admission) Increasing erythrocyte sedimentation rate (ESR) (greater than 71 mm per hour) Fat globules present in the sputum Emboli present in the retina on fundoscopy A least two positive major criteria plus one minor criteria or four positive minor criteria are suggestive of fat embolism syndrome. Fat embolism syndrome is a clinical diagnosis. There are no laboratory tests sensitive or specific enough to diagnose FES. Such laboratory tests are only used to suppo the clinical diagnosis only. Chest X ray may show diffuse interstitial infiltrates while chest CT scan will show diffuse vascular congestion and pulmonary oedema. Bronchoalveolar lavage has been proposed to look for fat droplets in alveolar macrophages however it is time consuming and is not specific to fat embolism syndrome. Looking for fat globules in sputum and urine is also not specific enough to diagnose FES Ref Davidson 23rd edtion pg 1010
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