Case of Severe Fat Embolism Treated by Intermittent Positive-pressure Respiration

Denman, Emily; Cairns, CJ; Holmes, C. McK.

doi:10.1136/bmj.2.5401.101

Cited by 15 publications

(4 citation statements)

References 4 publications

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“…Ashbaugh and Petty (1966) believed that severe pulmonary fat embolism reduced the compliance of the lungs and that subsequently severe hypoxia might prove fatal. Denman, Cairns and Holmes (1964) noted that the compliance of the lungs was greatly reduced in their case.…”

Section: Discussionmentioning

confidence: 96%

Latent Severe Anoxia Associated With the Fat Embolism Syndrome

Ross¹,

O'Higgins²

1968

British Journal of Anaesthesia

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Fat embolism syndrome was diagnosed in a 41-year-old man 42 hours after a road traffic accident. Latent severe anoxia was present and persisted despite endotracheal intubation and administration of oxygen when breathing was spontaneous. Oxygenation was restored almost immediately after instituting intermittent positive pressure ventilation. The need for frequent estimations of blood-gas tensions or oxygen saturation is emphasized. Pulmonary fat embolism is found at necropsy in 90-100 per cent of patients who have died shortly after receiving fractures (Sevitt, 1966) but clinical manifestations of this embolism develop in less than 2 per cent (Wilson and Salisbury, 1944; Saikku, 1954). The features most commonly associated with the fat embolism syndrome are: pyrexia, tachycardia, tachypnoea, haemoptysis, variable neurological signs, coma and a petechial rash. The following case is reported because it confirms recent evidence of latent severe anoxia associated with the fat embolism syndrome.

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Section: Discussionmentioning

confidence: 96%

Latent Severe Anoxia Associated With the Fat Embolism Syndrome

Ross¹,

O'Higgins²

1968

British Journal of Anaesthesia

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“…28 drug studies have been inconclusive Drugs suggested in the treatment of fat embolism syndrome include heparin, aspirin, dextran, hypertonic glucose, and alcohol, but the results have been inconclusive. 3,11,23,[40][41][42][43] Heparin stimulates lipase activity, consequently decreasing the concentration of circulating fat globules. However, the increase in levels of free fatty acids may actually worsen the clinical picture.…”

Section: ■ Case Concludedmentioning

confidence: 99%

“…For this reason, and because of anticoagulation concerns and evidence of increased mortality rates, heparin is now contraindicated in the treatment of fat embolism syndrome. 2,41,43 Alcohol. Patients with a higher blood alcohol level at the time of injury have been reported to have a lower incidence of fat embolism syndrome.…”

Section: ■ Case Concludedmentioning

confidence: 99%

Sudden hypoxia during knee surgery

Galway

Gugliotti

2012

CCJM

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Sudden hypoxia during knee surgery A 75-year-old man with type 2 diabetes and hypothyroidism underwent bilateral total knee replacement at our hospital. His functional capacity had been moderately limited by knee pain, but he could easily climb one flight of stairs without symptoms. His medications at that time included levothyroxine (Synthroid) and metformin (Glucophage). He had no known cardiac or pulmonary disease. The preoperative evaluation, including laboratory tests and electrocardiography, was within normal limits. Spinal anesthesia was used for surgery, and he was given 2 mg of midazolam (Versed) intravenously for sedation. No additional sedation was given. He was given oxygen via nasal cannula at 2 L/min. All vital signs were stable at the start of the procedure. However, about halfway through, when the thigh tourniquet was released, his oxygen saturation dropped abruptly from 100% to 92%. All other vital signs remained stable, and he was asymptomatic, was oriented to person, time, and place, was conversing freely, and was in no distress. The oxygen flow was increased to 6 L/min, his oxygen saturation improved, and the procedure was then completed as planned. At the conclusion of the surgery, before the patient was transported to the postanesthesia care unit (PACU) and while his oxygen flow rate was still 6 L/min, his oxygen saturation again dropped to 92%. A simple face mask was placed, and the oxygen flow rate was increased to 10 L/min. His oxygen saturation stayed low, near 90%. Bleeding during surgery had been nominal. He had received 2 L of lactated Ringer's solution and 500 mL of hetastarch (Hextend) during surgery. He continued to be asymptomatic in the PACU. EDUCATIONAL OBJECTIVE: Readers will consider the differential diagnosis of sudden hypoxia during orthopedic surgery.

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“…The message for health educators is clear: they must go forth and preach the gospel of dietary prudence. 1960-1964and 1968-1972. Cancer Center of Hawaii, 1976.…”

mentioning

confidence: 99%

Preventing fat embolism.

Brock‐Utne¹

1978

BMJ

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Case of Severe Fat Embolism Treated by Intermittent Positive-pressure Respiration

Cited by 15 publications

References 4 publications

Latent Severe Anoxia Associated With the Fat Embolism Syndrome

Latent Severe Anoxia Associated With the Fat Embolism Syndrome

Sudden hypoxia during knee surgery

Preventing fat embolism.

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