FAT EMBOLISM: A CURRENT CONCEPT

The fat embolism syndrome is a normal sequel to injury, and consists of respiratory and cerebral dysfunction and skin petechiæ. Respiratory dysfunction, the main feature of this syndrome, varies in its severity, and only severely affected patients have cerebral dysfunction and widespread skin petechiæ. The most important clinical guides to the severity of hypoxæmia include an increasing respiratory rate, central cyanosis, and the appearance of cerebral abnormalities and widespread skin petechias. Arterial blood gas analyses allow a more accurate assessment of hypoxæmia to be made in such patients. As a result of injury, many factors, including fat emboli, fibrin and platelet aggregates, circulate in the blood, and produce abnormalities in the pulmonary and systemic small vessels. These vascular abnormalities lead to the pathological changes observed in the lungs, brain and skin. However, resolution of these changes usually occurs within two weeks of the injury. The relative importance of fat emboli in the production of these pathological changes is unknown. Because of the uncertainty surrounding the effectiveness of the specific drug therapy of fat embolism, the present aim of treatment is to correct the functional changes, particularly hypoxæmia, and await the spontaneous resolution of the lung, brain and skin abnormalities.