Management of post-traumatic fat embolism in the emergency department

Abstract

Fat embolism following trauma is not commonly seen in the emergency department, since the signs and symptoms of post-traumatic fat embolism usually occur several hours or even days later. However, fat embolism is one of the major causes of death secondary to skeletal injuries. Everyday, there are a significant number of orthopaedic injuries or trauma presentations to every Emergency Department, which have potential to develop post-traumatic fat embolism. This article is intended to give an overview of pathophysiology, clinical manifestation and management of post-traumatic fat embolism. Through understanding the pathophysiology of post-traumatic fat embolism, emergency staff can actually play an important role in the preventive management of fat embolism following traumatic injury. Hulman described fat embolism as the mechanical blockage of the lumina of blood vessels by circulating fat particles. The first case of post-traumatic fat embolism was published by Zenker in 1862. From Zenker's studies, he stated that the embolised fat originated from the contents of a lacerated stomach although his patient also had fractured ribs. In 1990, the studies of Levy and Liu et al, suggested that more than 90% of traumatic injuries were found to have fat embolism in organs and tissues. Considering the complications of orthopaedic trauma, fat embolism is an important cause of secondary death. Fat embolism can occur 12 to 48 hours or even up to 10 days post traumatic injury. Schwartz et al, states that, the progress of the fat embolism is affected by the degree of mobility of injured tissue and the condition of circulation. The mobilisation of fat emboli is also affected by the presence of hypovolaemia.