A young male presented with dyspnea, bleeding and petechial hemorrhage in the chest after 2 days following fracture shaft of the femur right side. Most likely cause is
Correct Answer: Fat embolism
Description: (Fat -embolism) (855-56-CSDT 12th) (178-Anaesthesia- A. yadav 3rd)FAT-EMBOLISM - Fracture through a large marrow filled 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 and severe shock or in patients with associated chest injuries) it results in progressive respiratory distress and multi - organ failure (ARDS)* Blood gases should be measured soon after admission, and may suspicious signs such as shortness of breath, restless ness or a rise in temperature or pulse rate should prompt a search for petechal hemorrhages over the upper body axillae and conjunctivae* TRIAD of fat embolism - Dyspnea, confusion and petechial haemorrhage.* Capnography show fall in endtidal CO2 (ETCO2 may become zero if embolus is large enough to block the main pulmonary artery* Coagulation abnormalities like increased clotting time and decreased platelets* Serum lipase is increased* Air embolism - occure during the placement or removal of central venous catheters* Amniotic fluid-embolism - occur during active labour* Fat embolism - occur from long bones fractures- Characterised by respiratory insufficiency, Coagulopathy, encephalopathy and an upper body petechial rash* Pulmonary embolism - results from septic emboli, tumour emboli from atrial myxoma or IVC extension of renal cell carcinoma and parasitic emboli**DVT remains the most common source of pulmonary thromboembolism
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