Fat embolism syndrome primary prevention: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Fat embolism syndrome}} | {{Fat embolism syndrome}} | ||
{{CMG}} ; {{AE}} {{FT}} | |||
==Overview== | ==Overview== | ||
Effective measurement for the primary [[Prevention (medical)|prevention]] of fat embolism include early fixation of long bone fractures, external fixation with a plate and screw and use of small-diameter nails. | |||
==Primary Prevention== | ==Primary Prevention== | ||
Effective measurement for the primary prevention of fat embolism are as follows:<ref name="pmid20839434">{{cite journal| author=Jiang J, Wang H, Wang Y| title=[Clinical study on effect of dexamethasone in preventing fat embolism syndrome after cemented hip arthroplasty]. | journal=Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi | year= 2010 | volume= 24 | issue= 8 | pages= 913-6 | pmid=20839434 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20839434 }} </ref> | Effective measurement for the primary [[Prevention (medical)|prevention]] of fat embolism are as follows:<ref name="pmid20839434">{{cite journal| author=Jiang J, Wang H, Wang Y| title=[Clinical study on effect of dexamethasone in preventing fat embolism syndrome after cemented hip arthroplasty]. | journal=Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi | year= 2010 | volume= 24 | issue= 8 | pages= 913-6 | pmid=20839434 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20839434 }} </ref> | ||
=== Pre-operative preventive measures: === | === Pre-operative preventive measures: === | ||
*Preoperative intravenous injection of dexamethasone<ref name="pmid18278374">{{cite journal| author=Cavallazzi R, Cavallazzi AC| title=[The effect of corticosteroids on the prevention of fat embolism syndrome after long bone fracture of the lower limbs: a systematic review and meta-analysis]. | journal=J Bras Pneumol | year= 2008 | volume= 34 | issue= 1 | pages= 34-41 | pmid=18278374 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18278374 }} </ref> | *Preoperative [[Intravenous therapy|intravenous]] injection of [[dexamethasone]].<ref name="pmid18278374">{{cite journal| author=Cavallazzi R, Cavallazzi AC| title=[The effect of corticosteroids on the prevention of fat embolism syndrome after long bone fracture of the lower limbs: a systematic review and meta-analysis]. | journal=J Bras Pneumol | year= 2008 | volume= 34 | issue= 1 | pages= 34-41 | pmid=18278374 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18278374 }} </ref> | ||
*Continuous pulse oximetry to detect hypoxemia at early stages.<ref name="pmid14960980">{{cite journal| author=Wong MW, Tsui HF, Yung SH, Chan KM, Cheng JC| title=Continuous pulse oximeter monitoring for inapparent hypoxemia after long bone fractures. | journal=J Trauma | year= 2004 | volume= 56 | issue= 2 | pages= 356-62 | pmid=14960980 | doi=10.1097/01.TA.0000064450.02273.9B | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14960980 }} </ref><ref name="pmid11778316">{{cite journal| author=Schmidt J, Sulk C, Weigand C, La Rosée K, Schneider T| title=[Preventing fat embolism syndrome (FES) in implantation of cemented hip endoprosthesis shafts with a trans-prosthetic drainage system (TDS)]. | journal=Biomed Tech (Berl) | year= 2001 | volume= 46 | issue= 11 | pages= 320-4 | pmid=11778316 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11778316 }} </ref><ref name="pmid6354030">{{cite journal| author=Schonfeld SA, Ploysongsang Y, DiLisio R, Crissman JD, Miller E, Hammerschmidt DE et al.| title=Fat embolism prophylaxis with corticosteroids. A prospective study in high-risk patients. | journal=Ann Intern Med | year= 1983 | volume= 99 | issue= 4 | pages= 438-43 | pmid=6354030 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6354030 }} </ref> | *Continuous [[pulse]] oximetry to detect [[hypoxemia]] at early stages.<ref name="pmid14960980">{{cite journal| author=Wong MW, Tsui HF, Yung SH, Chan KM, Cheng JC| title=Continuous pulse oximeter monitoring for inapparent hypoxemia after long bone fractures. | journal=J Trauma | year= 2004 | volume= 56 | issue= 2 | pages= 356-62 | pmid=14960980 | doi=10.1097/01.TA.0000064450.02273.9B | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14960980 }} </ref><ref name="pmid11778316">{{cite journal| author=Schmidt J, Sulk C, Weigand C, La Rosée K, Schneider T| title=[Preventing fat embolism syndrome (FES) in implantation of cemented hip endoprosthesis shafts with a trans-prosthetic drainage system (TDS)]. | journal=Biomed Tech (Berl) | year= 2001 | volume= 46 | issue= 11 | pages= 320-4 | pmid=11778316 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11778316 }} </ref><ref name="pmid6354030">{{cite journal| author=Schonfeld SA, Ploysongsang Y, DiLisio R, Crissman JD, Miller E, Hammerschmidt DE et al.| title=Fat embolism prophylaxis with corticosteroids. A prospective study in high-risk patients. | journal=Ann Intern Med | year= 1983 | volume= 99 | issue= 4 | pages= 438-43 | pmid=6354030 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6354030 }} </ref> | ||
*Early fixation of long-bone [[fracture]] | *Early fixation of long-bone [[fracture]]. | ||
*External fixation or fixation with plate and screw decreases the possibility of fat embolism than than nailing the medullary cavity and venting the medullary canal during nailing.<ref name="pmid11778316">{{cite journal| author=Schmidt J, Sulk C, Weigand C, La Rosée K, Schneider T| title=[Preventing fat embolism syndrome (FES) in implantation of cemented hip endoprosthesis shafts with a trans-prosthetic drainage system (TDS)]. | journal=Biomed Tech (Berl) | year= 2001 | volume= 46 | issue= 11 | pages= 320-4 | pmid=11778316 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11778316 }} </ref> | *External fixation or fixation with plate and screw decreases the possibility of fat [[embolism]] than than nailing the medullary cavity and venting the [[Medulla|medullary]] canal during nailing.<ref name="pmid11778316">{{cite journal| author=Schmidt J, Sulk C, Weigand C, La Rosée K, Schneider T| title=[Preventing fat embolism syndrome (FES) in implantation of cemented hip endoprosthesis shafts with a trans-prosthetic drainage system (TDS)]. | journal=Biomed Tech (Berl) | year= 2001 | volume= 46 | issue= 11 | pages= 320-4 | pmid=11778316 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11778316 }} </ref> | ||
*If nails are needed, smaller-diameter nails and unreamed nailing may be better.<ref name="pmid9795426">{{cite journal| author=Pitto RP, Kössler M, Draenert K| title=[Prevention of fat and bone marrow embolism in cemented total hip endoprosthesis with vacuum cement technique]. | journal=Z Orthop Ihre Grenzgeb | year= 1998 | volume= 136 | issue= 4 | pages= Oa24 | pmid=9795426 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9795426 }} </ref> | *If nails are needed, smaller-diameter nails and unreamed nailing may be better.<ref name="pmid9795426">{{cite journal| author=Pitto RP, Kössler M, Draenert K| title=[Prevention of fat and bone marrow embolism in cemented total hip endoprosthesis with vacuum cement technique]. | journal=Z Orthop Ihre Grenzgeb | year= 1998 | volume= 136 | issue= 4 | pages= Oa24 | pmid=9795426 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9795426 }} </ref> | ||
=== In-operation preventive measures: === | === In-operation preventive measures: === | ||
In patients having surgery for long bone fractures following preventive measures should be taken: | In patients having [[surgery]] for long bone [[Bone fracture|fractures]] following preventive measures should be taken: | ||
* Early detection of the symptoms by careful vigilence and high degree of clinical suspicion. | * Early detection of the symptoms by careful vigilence and high degree of clinical suspicion. | ||
* Continuous monitoring for the fall in oxygen saturation. | * Continuous monitoring for the fall in [[oxygen]] saturation. | ||
* An early initiation of supplemental oxygen and steroids may help in inhibiting the hypoxic insult and manifestations of full-blown FES. | * An early initiation of supplemental oxygen and steroids may help in inhibiting the [[Hypoxemia|hypoxic]] insult and manifestations of full-blown FES. | ||
* The patient should be over sedated. | * The patient should not be over sedated. | ||
* Careful monitroing of vitals and temperature is mandatory. | * Careful monitroing of vitals and temperature is mandatory. | ||
* Periodic neurological assessment. | * Periodic [[Neurology|neurological]] assessment. | ||
* Albumin should be used for volume resuscitation as it binds with free fatty acids and reduces lung injury. | * [[Albumin]] should be used for volume resuscitation as it binds with free fatty acids and reduces [[lung]] injury. | ||
==References== | ==References== | ||
Latest revision as of 03:56, 6 April 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Feham Tariq, MD [2]
Overview
Effective measurement for the primary prevention of fat embolism include early fixation of long bone fractures, external fixation with a plate and screw and use of small-diameter nails.
Primary Prevention
Effective measurement for the primary prevention of fat embolism are as follows:[1]
Pre-operative preventive measures:
- Preoperative intravenous injection of dexamethasone.[2]
- Continuous pulse oximetry to detect hypoxemia at early stages.[3][4][5]
- Early fixation of long-bone fracture.
- External fixation or fixation with plate and screw decreases the possibility of fat embolism than than nailing the medullary cavity and venting the medullary canal during nailing.[4]
- If nails are needed, smaller-diameter nails and unreamed nailing may be better.[6]
In-operation preventive measures:
In patients having surgery for long bone fractures following preventive measures should be taken:
- Early detection of the symptoms by careful vigilence and high degree of clinical suspicion.
- Continuous monitoring for the fall in oxygen saturation.
- An early initiation of supplemental oxygen and steroids may help in inhibiting the hypoxic insult and manifestations of full-blown FES.
- The patient should not be over sedated.
- Careful monitroing of vitals and temperature is mandatory.
- Periodic neurological assessment.
- Albumin should be used for volume resuscitation as it binds with free fatty acids and reduces lung injury.
References
- ↑ Jiang J, Wang H, Wang Y (2010). "[Clinical study on effect of dexamethasone in preventing fat embolism syndrome after cemented hip arthroplasty]". Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 24 (8): 913–6. PMID 20839434.
- ↑ Cavallazzi R, Cavallazzi AC (2008). "[The effect of corticosteroids on the prevention of fat embolism syndrome after long bone fracture of the lower limbs: a systematic review and meta-analysis]". J Bras Pneumol. 34 (1): 34–41. PMID 18278374.
- ↑ Wong MW, Tsui HF, Yung SH, Chan KM, Cheng JC (2004). "Continuous pulse oximeter monitoring for inapparent hypoxemia after long bone fractures". J Trauma. 56 (2): 356–62. doi:10.1097/01.TA.0000064450.02273.9B. PMID 14960980.
- ↑ 4.0 4.1 Schmidt J, Sulk C, Weigand C, La Rosée K, Schneider T (2001). "[Preventing fat embolism syndrome (FES) in implantation of cemented hip endoprosthesis shafts with a trans-prosthetic drainage system (TDS)]". Biomed Tech (Berl). 46 (11): 320–4. PMID 11778316.
- ↑ Schonfeld SA, Ploysongsang Y, DiLisio R, Crissman JD, Miller E, Hammerschmidt DE; et al. (1983). "Fat embolism prophylaxis with corticosteroids. A prospective study in high-risk patients". Ann Intern Med. 99 (4): 438–43. PMID 6354030.
- ↑ Pitto RP, Kössler M, Draenert K (1998). "[Prevention of fat and bone marrow embolism in cemented total hip endoprosthesis with vacuum cement technique]". Z Orthop Ihre Grenzgeb. 136 (4): Oa24. PMID 9795426.