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From: Gautam
> We have a very experienced ortho reg at present, who told me that fixing
> femur shafts is considered an urgent life-saving procedure in Germany
> (from whence he comes), BECAUSE of the risk of FES if left>24hrs.
Agreed, as just covered in my previous post.
> As a non-orthopod, can someone tell me how you diagnose FES, from say
> Thromo-embolism? Is it purely by exclusion, is there some fancy
> expensive test, or is it clinically obvious?
Goat, fat embolism is very different from thromboembolism, but of course we
never see it in A&E, I haven't seen one for years...
To quickly summarise fat embolism...usually 1 to 2 days post trauma,
confusion & drowsiness, later convulsions & coma, pyrexia & tachycardia,
petechial rash classically of upper trunk, axillae and neck, dyspnoea &
tachypnoea, later cyanosis, occasionally frothy sputum, fluffy shadows on
CXR, retinal changes (but could never see those myself). Labs will include
hypoxia and hypocapnia, thrombocytopenia, high ESR and there are other more
obscure ones.
Basically it's a clinical diagnosis, and there can be overlap with ARDS etc,
but my intensive care medicine is way out of date so don't ask me to
accurately define ARDS! At the end of the day, we don't have to worry much
about fat embolism in A&E, I'm pleased to say.
Regards
Adrian Fogarty
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