A 20-year-old man, who, 36 hours after admission to the hospital for injuries sustained in a motor vehicle collision, has sudden onset of shortness of breath and confusion. The orthopedetians quickly decides for placement of an external fixator device for open fractures of the left tibia and fibula. Current medications include morphine. The patient is confused and he is not oriented to person, place, or time. His temperature is 39.2°C (102.7°F), pulse is 112/min, respirations are 25/min, and blood pressure is 102/48 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 88%. On examination, there are petechiae on the shoulders, chest, and axillae. There is no evidence of bleeding in the lower extremities.Chest x ray shows bilateral patchy infiltrates.
What is the most likely Dx?
ARDS result from hemorrhagic shock in this pat or fat emboli of fracture. Now the septic shock and even the acute pancreatitis of impact of accident and also give him morphine ( no,no)-----and DIC also would cause ARDS and last if he had transfusion RX may cause of ARDS.
Fat Embolism Syndrome.
Clinical triad of neurological abnormalities, hypoxemia and petechial rashes.
I will go for Fat embolism!
Fat embolism is the cause of pt's ARDS
can also consider ARDS due to
1.possible multiple injury
2. Acute onset
3. Bilateral diffuse infiltrate of the lungs
but ARDS mostly occur about 72 hours after the trigger or injury
Microscopic pulmonary fat embolism is ALMOST universal ------TRUMA is usually NOT ass with fat embolism SYNDROME and is rarely fatal (syndrome usually take few days after 3-4 days and that emboli degard by lipoprotein lipase --------------Toxic FFA------which then also damge the capillary endothelium & alvelolar epi--------ARDS.