Fat embolism in Trinidad and Tobago - abstract

ABSTRACT

The fat embolism syndrome is under-diagnosed because of low suspicion and this study was done to increase physician awareness and improve management. In the 6 years, 1984-1989 at San Fernando General Hospital, Trinidad, there were 10 cases - 1,2,2,1,1 and 3 in the years, respectively. Six were in the 3rd decade and all male, motor vehicle accidents accounted for 9 and a fall for one. There was poor attention to on-site immobilisation and sometimes delay in patients' transfer to hospital. Diagnosis was usually made on the 2nd or 3rd day. Eight patients had femoral fractures, one a bilateral, one a tibial and one a radial fracture. Soft tissue injury was common. Symptoms were alteration in level of consciousness in 9 with progression to coma in 3. Four had respiratory distress, 8 had conjunctival petechial haemorrhages, 3 respiratory crepitations and rhonchi and 2 tachycardia. Six had elevated temperature profile and gm/100ml haemoglobin was less than 10 and haematocrit less than 30 ml/100 ml in 4. Platelet count was normal in 6 tested. Treatment was with oxygen, antibiotics and steroids (Decadron or hydrocortisone), plaster immobilisation of the tibia and radius, skeletal traction in the 6 with femoral fractures and internal Kuntschner (K-nail) fixation was done in 5 at 12-19 days post injury. One had early K-nail at 12 hours post surgery. Nine showed complete recovery; however, complications of respiratory distress, siezures and renal failure resulted in one mortality. Sufficient facilities for arterial blood gasses and other parameters were not available for diagnosis and monitoring treatment. Treatment outcome was good because of aggressive management of oxygen, antibiotics and steriods. Long bone fractures need to be fixed early to reduce the incidence of fat embolism (AU)