A 16-year-old girl was involved in a car accident on her way to school, resulting in a fracture of her left thigh. She was sent to the hospital for diagnosis and treatment, and then underwent intramedullary nail fixation surgery. Unexpectedly, the patient showed up the next day after the surgery. I had high fever, respiratory distress, and chest pain. I quickly went to an interdisciplinary consultation and found out that the fat particles in the bones were released during the fracture, entered the blood circulation through the broken blood vessels, and finally traveled to the lungs to cause pulmonary embolism. Fortunately, he was discovered early. Under the joint treatment of the medical team, he stayed in the intensive care unit for a few days and finally recovered and was discharged successfully.
A simple fracture can be so severe that life-threatening breathing difficulties occur. This disease, which seems to have nothing to do with fractures, is the so-called "fat embolism syndrome." What is fat embolism syndrome?
Fat embolism syndrome usually occurs in patients with fractures. It usually occurs within 3 days after the injury, especially in patients with long bone (thigh bone, calf bone) fractures or multiple fractures. The probability of occurrence is approximately It is only about 1, but the mortality rate is as high as 15 to 20, which can be said to be a serious complication after fracture.
Especially young people or obese people, because of poor blood circulation or more fat, are prone to the oil in the bone marrow cavity circulating with the blood to the lungs, causing diffuse pulmonary infiltration and leading to breathing problems. Difficulty, central nervous system changes, symptoms such as lethargy or spasm, and fat droplets appearing in the blood and urine, which may even flow to the brain through the arterial duct and cause cerebral embolism. However, because the amount of oil is not large, most of the time only "purple spot" rashes with spotty bleeding will appear on the surface of the skin such as the armpits. The symptoms of fat embolism vary greatly in severity
The reason why fat embolism syndrome is scary is not only because fat droplets can block small blood vessels. The free fatty acids produced by it can damage vascular endothelial cells. Severe damage occurs, and the clinical symptoms of patients will vary greatly. In mild cases, people may only feel difficulty breathing, which can be relieved by inhaling oxygen, but in severe cases, they may need ventilator support to survive, and may even cause breathing problems. Exhaustion and rapid death.
How to treat fat embolism syndrome?
Faced with this fat embolism syndrome with low incidence but high mortality, the medical community currently has no proven effective treatment or prevention methods. The only way to treat the patient is to treat the fracture as soon as possible when the patient has a fracture. The affected part is immobilized and movement of the affected limb is avoided to reduce the outflow of intraosseous fat in the long bones.
Once the patient becomes unconscious, has shortness of breath or is in distress, and purple ecchymoses appear on the chest or armpits, arterial blood needs to be drawn immediately, oxygen supplied, and assisted ventilation treatment to provide support. Sexual therapy allows the body to metabolize the fat that enters the blood within 3 to 5 days by giving oxygen. Due to the invention of respirators and the advancement of medical technology, the mortality rate of fat embolism syndrome caused by fractures has been gradually reduced.