| Hipoxemia postoperatoria debida a embolismo graso |
Postoperative hypoxemia due to fat embolism.
Bhalla T, Sawardekar A, Klingele K, Tobias JD.
Department of Anesthesiology, Nationwide Children's Hospital and the Ohio State University, Columbus, Ohio.
Saudi J Anaesth. 2011 Jul;5(3):332-4.
Abstract
Although the reported incidence of fat embolism syndrome (FES) is low (approximately 1%), it is likely that microscopic fat emboli are showered during manipulation of long bone fractures. Even though there continues to be debate regarding the etiology and proposed mechanism responsible for FES, significant systemic manifestations may occur. Treatment is generally symptomatic based on the clinical presentations. We report a 10-year-old girl who developed hypoxemia following treatment of a displaced Salter-Harris type II fracture of the distal tibia. The subsequent evaluation and hospital course pointed to fat embolism as the most likely etiology for the hypoxemia. We discuss the etiology for FES, review the proposed pathophysiological mechanisms responsible for its clinical manifestations, present currently accepted diagnostic criteria, and discuss its treatment.
http://www.saudija.org/text.asp?2011/5/3/332/84115
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| Análisis del embolismo graso en pacientes de trauma del AIIMS Apex Trauma Center, New Delhi, India |
Analyzing fat embolism syndrome in trauma patients at AIIMS Apex Trauma Center, New Delhi, India.
Gupta B, D'souza N, Sawhney C, Farooque K, Kumar A, Agrawal P, Misra MC.
Department of Anesthesia, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India.
J Emerg Trauma Shock. 2011 Jul;4(3):337-41.
Abstract
BACKGROUND: Fat embolism syndrome (FES) is a constellation of symptoms and signs subsequent to orthopedic trauma. MATERIALS AND METHODS: The clinical profile of FES in the trauma population was studied over 2 years and 8 months. RESULTS: The incidence of FES among all patients with long bone and pelvic fractures was 0.7% (12). The mean injury severity score was 10.37 (SD 1.69) (range 9-14). The diagnosis of FES was made by clinical and laboratory criteria. Hypoxia was the commonest presentation (92%). The average days of onset of symptoms were 3.5 (SD1.29) days. Management included ventilator support in 75%, average ventilator days being 7.8 (SD 4.08) days. The average ICU stay and hospital stay were 9.1 days and 29.7 days, respectively. A mortality of 8.3% (1) was observed. CONCLUSION: Fat embolism remains a diagnosis of exclusion and is a clinical dilemma. Clinically apparent FES is unusual and needs high index of suspicion, especially in long bone and pelvic fractures.http://www.onlinejets.org/text.asp?2011/4/3/337/83859 |
Ecocardiografía transesofágica para la detección de la propagación de embolia masiva durante prótesis de cadera
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Transesophageal echocardiography for detection of propagating, massive emboli during prosthetic hip fracture surgery.
Shine TS, Feinglass NG, Leone BJ, Murray PM.
Division of Anesthesia Services, Mayo Clinic, Jacksonville, Florida 32224, USA.
Iowa Orthop J. 2010;30:211-4.
Abstract
Fat embolus has been known to occur during major orthopedic surgery. In many cases, fat embolus syndrome is a postoperative complication of long bone orthopedic surgery, particularly femoral fractures occurring after trauma. Changes in intraoperative cardiopulmonary function have been reported in a subset of these patients, and they are associated with the degree of embolization occurring with manipulation or cementing of prostheses in the fractured femur. Intraoperative cardiovascular collapse has been reported, and this cardiac event is temporally associated with intramedullary manipulations such as reaming or cementing. We present a rare case of fatal intraoperative fat embolization diagnosed with trans-esophageal echocardiography.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958300/pdf/iowa0030-0211.pdf
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| Embolia grasa como complicación de politraumatismo por precipitación autolítica. |
J. Lucena, M. Salguero, A. Rico, M. Blanco, R. Marín, E. Barrero, L. Miguel1 y FF. Cruz-Sanchez
Cuad Med Forense 2005; 11(40):131-137
RESUMEN
El síndrome de embolia grasa (SEG) es un cuadro clínico debido a la oclusión de los vasos sanguíneos por glóbulos de grasa. Se asocia fundamentalmente a fracturas de los huesos largos y es una importante fuente de morbilidad y mortalidad en pacientes politraumatizados. Aunque las primeras descripciones se realizaron a finales del siglo XIX en la actualidad sigue siendo un desafío para el clínico por lo que, en ocasiones, el diagnóstico inicial se realiza en la autopsia. Presentamos un caso de SEG en una mujer de 19 años que fallece en el hospital doce días después de precipitarse desde un puente con finalidad suicida sufriendo politraumatismo con fractura de huesos largos. El SEG fue sospechado clínicamente y se diagnosticó en la autopsia macroscópica siendo posteriormente confirmado por los estudios histopatológicos. Así mismo se revisan las características clinico-patológicas del SEG.
Palabras clave: Embolia grasa, fracturas de huesos largos, suicidio, patología forense.
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