A 34-year-old male undergoing an emergent open reduction and internal fixation of his left femur suddenly develops tachycardia, hypotension and hypoxemia. Fat embolism syndrome (FES) is suspected. All of the following are considered a part of the major clinical criteria for the diagnosis of FES proposed by Gurd EXCEPT:
A. Respiratory symptoms with radiographic changesCorrect Answer: B
Fat embolism syndrome (FES) is most often seen in orthopedic patients with long bone fractures. Although rare, liposuction, bone marrow harvest, and sickle cell crisis could also be complicated by FES. The clinical manifestations of FES are considered to occur as a result of the proinflammatory and prothrombotic effects of fat cells, resulting in either mechanical obstruction or biochemical injury. Gurd criteria are the most commonly used or cited diagnostic criteria for FES. Gurd criteria typically require the presence of one major and four minor criteria to make a clinical diagnosis of FES. The major criteria include respiratory insufficiency, cerebral involvement, and petechial rash. The minor criteria include tachycardia, fever, jaundice, retinal changes, and renal changes. The treatment of FES is largely supportive with some studies advocating the use of heparin and corticosteroids.
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