A 24-year-old man is admitted to the hospital after sustaining a closed midshaft femur fracture in a motor vehicle collision. The fracture is temporarily immobilized in a traction splint, and he is scheduled for operative fixation the following morning. Twelve hours after admission, he develops sudden-onset shortness of breath, confusion, and a new petechial rash over his chest and anterior neck. Vital signs show a temperature of 37.6°C (99.7°F), blood pressure of 122/78 mmHg, pulse of 118/min, and respirations of 26/min. Oxygen saturation is 86% on room air. Auscultation of the lungs reveals scattered bilateral crackles. Which of the following is the most likely diagnosis?
- AAcute decompensated heart failure
- BAspiration pneumonitis
- Fat embolism syndromeAnswer
- DOpioid-induced respiratory depression
- EPulmonary contusion
Answer
Fat embolism syndrome
The correct answer is fat embolism syndrome (FES). FES is a life-threatening complication that most commonly occurs 12 to 72 hours after a severe traumatic injury involving long bone fractures (e.g., femur) or pelvic fractures. Fat globules from the bone marrow enter the systemic circulation and cause microvascular occlusion and a systemic inflammatory response. The classic clinical triad includes respiratory distress (hypoxia, tachypnea, crackles), neurologic dysfunction (confusion, agitation, altered mental status), and a petechial rash (typically on the head, neck, anterior thorax, and axillae). This patient exhibits all three components of the triad following a midshaft femur fracture.
Step-by-Step Solution
Key Concept
The classic clinical triad of fat embolism syndrome includes respiratory distress, neurologic dysfunction, and a petechial rash, typically occurring 12 to 72 hours after a long bone or pelvic fracture.
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