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Fat embolism outcome. Fat embolism - description, causes, diagnosis and treatment

Fat embolism outcome. Fat embolism - description, causes, diagnosis and treatment

Fat embolism occurs in injuries with fractures of long tubular bones and pelvic bones. In this case, its development ranges from 0.5 to 30%. It also occurs in other well-known diseases and disorders. Pathology is quite dangerous, the probability of death is from 3 to 67%.

At the same time, this problem has not been fully studied by modern medical science, which complicates the practice of using preventive and therapeutic methods of exposure. So how do you react and overcome?

The reasons

Embolism (from the ancient Greek "invasion") is a pathological process, as a result of which particles enter the bloodstream, which under normal conditions should not be there. These particles (emboli) at a high accumulation can lead to blockage of the vessel, which will further affect the blood supply to the organ/tissue.

Fat embolism is determined by the fact that fat droplets clog the vessels of the microvasculature, involving capillaries in the pathological process. Pathology develops rapidly, and the first manifestations are detected 1-3 days after injury or other exposure.

This pathology has no age or gender restrictions, as well as the influence of the general condition of the body. And yet, a certain type of injury and certain types of effects on the human body are distinguished, in which the development of the disease is possible.

Embolization may develop:

with fractures of tubular bones;
with a fracture of the pelvic bones;
with multiple injuries with damage to bone tissue;
after bone marrow surgery;
after amputation;
on the background diabetes and acute pancreatitis;
after receiving burn injuries;
with prolonged use of corticosteroid drugs;
after a liposuction session;
as a complication of osteomyelitis.

The disease can proceed, adopting signs of pneumonia, traumatic brain injury, ARDS in adults and a number of other diseases. This greatly complicates the diagnosis of the pathological process, which, as a result, affects the mortality statistics.

signs

Droplets of fat that have entered the blood do not immediately manifest themselves. They move through the bloodstream, mixing with blood elements. Some clog into small vessels, while others continue to move, gradually accumulating. So in a day a large number of capillaries throughout the body are blocked.

The pathology does not have a specific localization, since the circulatory system passes through the entire body. The first signs of the pathological process are small hemorrhages. They mainly appear in the neck, shoulders, chest, armpits, many of them are invisible to the naked eye.

Shortness of breath appears after embolization of the pulmonary capillaries. Reduced oxygen in the blood leads to cyanosis, a dry cough. An embolism in the region of the heart leads to the development of tachycardia. Other symptoms include fever, confusion.

Fat emboli can "sit" in place or move, which is much more dangerous. This is precisely the difficulty of diagnostics: it is almost impossible to predict how particles will behave at a given moment.

However, it is possible with a high probability to conclude what pathologies of the organ will develop when a fatty thrombus enters:

cardiac muscle - acute heart failure;
kidneys - renal failure (symptom - oliguria);
lungs - respiratory failure;
brain - stroke and so on.

That is why it is so difficult to predict the consequences of the disease. And that's why deaths are recorded so often.

Diagnostics

If the disease is so unpredictable, how can it be detected? A comprehensive diagnosis is required.

Magnetic resonance imaging will help in the detection of cerebral fat embolism.
Computed tomography can exclude other intracranial lesions.
X-ray examination of the lungs will confirm the symptoms of ARDS, which in turn will rule out pneumothorax.
Pulse oximetry and control of intracranial pressure.
Blood test for hemoglobin, fibrinogen, platelet count. Detection of fat in the blood.
Analysis of urine, cerebrospinal fluid, sputum.
Biopsy of the skin to detect fat.
Examination of the eyeballs for fatty angiopathy of the retina.

After surgery, amputation or therapeutic manipulations for injuries, the patient spends several days in the hospital. Thus, it is much easier to monitor the condition, which increases the likelihood of timely detection of pathology.

Therapeutic impact

Due to the special nature of the disease, urgent treatment is required, which is carried out in intensive care.

Early operative stabilization of the injury helps to reduce the risk of fat embolism in injuries with fractures. Immobilization by skeletal traction can then be dangerous. Therefore, the optimal solution in the treatment of injuries of large tubular bones is surgical fixation of bone fragments (pin osteosynthesis).

As for the medical course of treatment, unfortunately, no direct drugs have been developed for this group of pathologies. And yet a number of prescriptions are possible. Therapeutic measures here are aimed at stopping the main symptoms of an injury or illness. And this means that it is not a fat embolism that is being treated, but a traumatic disease.

Fat embolism, although it is a rapidly affecting and dangerous disease, but it can be fought. The main thing is to detect and take appropriate therapeutic measures in time. One of the main points of early prevention is the provision of high-quality first aid to the victim. Immediate but gentle transport to a medical facility.

24.09.2017

An embolism is a pathological condition of the blood vessels, when they are clogged with substances that are not normally found in the vascular bed. In particular, blockage of blood vessels by fat particles is what a fat embolism is. In most clinical cases, the cause of the pathology is trauma to the tubular bones, but there are other factors that cause embolism.

Fat embolism is a disease that needs to be treated on time

similarity clinical manifestations blockage of blood vessels with fat with signs of head injury, pneumonia, leads to errors in diagnosis, often to death due to untimely assistance. The disease is more often diagnosed in young men because of their vigorous activity, which often leads to fractures.

Why does a fat embolism occur?

There should be no fat particles in the blood vessels, but it can enter the bloodstream due to various factors. This can include amputation surgery, a fracture in obese people, excessive bone marrow pressure, and diabetes. In many identified cases, fat embolism occurred with large blood loss in case of extensive damage or during surgery. People with hypotension are at risk.

Not every fracture is fraught, statistics say that a complication occurs in about 10% of all cases of injury. Data on mortality in pathology is disappointing - about 50% of patients die.

Fat embolism most often occurs with large blood loss

Other causes of fat embolism syndrome are burns to large areas of the body, liver injury, and severe tissue damage. In very rare cases, the pathology provokes a closed massage of the heart muscle.

Scientists give different mechanisms for the onset and further course of pathology. The main factor is the increase in bone marrow pressure, which leads to the ingress of fat particles into the venous circulation. According to another opinion, thickening of the blood in case of severe bleeding activates lipase, and with it the number of fat cells. The third (and not the last) theory points to a change in the size of fats in plasma.

Classification of fat embolism

Doctors distinguish 3 types of fat embolism - it is pulmonary, mixed and cerebral. Classification is carried out on the basis of the localization of fatty particles - in the lungs, kidneys and brain tissues, and other organs.

There are three types of fat embolism

Taking into account the rate of development of pathology, embolism is divided into fulminant, when a fatal outcome occurs within a couple of minutes, as well as acute and subacute. The acute form is detected a couple of hours after the injury, subacute - within 12-72 hours. In the last two forms, the mortality rate is lower, because doctors have time to dissolve fats in the vessels, restore blood flow without harm to the state of vital organs.

Clinical picture

The period of manifestation of the first symptoms, as mentioned above, lasts from a couple of minutes to 3 days from the moment of the event that provoked the entry of fats into the bloodstream. The initial course is characterized by small hemorrhages on the neck and shoulders, in the armpits and chest area.

Sometimes such small hemorrhages cannot be noticed without a magnifying glass. Such signs stay on the skin from a couple of hours to a couple of days. This suggests that there is a blockage of the capillaries and there is a traumatic injury. Sometimes hemorrhage is detected in the conjunctiva and in the fundus. An ophthalmologist may notice blood clots from fat cells in the vessels during the assessment of the fundus.

Doctors divide the main signals of fat embolism into 4 syndromes:

Disorders in the work of the central nervous system. These are paresis, paralysis, confusion, severe headache, delirium, convulsions and coma.
Hypothermic fat embolism syndrome. Raised febrile temperature cannot be reduced with antipyretic drugs. Heat appears due to the fact that fatty acids irritate the brain structures responsible for thermoregulation.
Violation of the activity of the heart, respiratory system. Shortness of breath appears, breathing can completely stop. In the sternum - pain, there is a cough with blood in the sputum, tachycardia. Listening to the heart, the doctor detects a strong second tone, and fine bubbling rales in the lungs.
Small on the skin, which were mentioned above.

Separately, it should be considered that accompanies pulmonary embolism. This form of pathology is detected more often than others - it accounts for about 60% of all cases. The condition can be recognized by the following symptoms: dry cough, shortness of breath, frothy sputum with blood inclusions, cyanosis. Urgent diagnosis and treatment is required.

In the case of brain damage, the signs of the first syndrome predominate. If a person has tissues of several organs affected, the clinical picture is mixed. If thromboembolism causes respiratory failure, it is necessary to ventilate the lungs, insert a breathing tube - only such measures can save a life.

Diagnostic measures

Pathology is confirmed not only by the presence of symptoms, but also by diagnostic measures. To do this, there are laboratory and instrumental methods that detect fatty compounds with dimensions of 6 microns in the blood. During the research, doctors discover:

increased fat in alveolar macrophages;
diffuse infiltration in the lungs;
swelling of the retina, the presence of silver spots, signaling impaired blood circulation in the eye vessels;
breakdown of red blood cells leading to anemia;
increase in ESR;
the leukocyte formula shifts to the left, leukocytosis develops;
protein and blood in the urine;
fat cells in the urine (lipuria);
microscopic hemorrhages in the brain;
swelling of the brain and the death of its tissues, myelin degeneration, perivascular infarction.

X-ray is one of the methods for diagnosing this disease.

The listed results are obtained using x-rays, laboratory blood and urine tests, magnetic resonance imaging and other types of diagnostic measures. Based on the results and the symptoms listed above, the doctor establishes the final diagnosis and prescribes treatment.

In most cases, embolism is manifested by symptoms, the spectrum of which depends on the localization of inflammation - with blockage of the blood vessels of the kidneys and spleen, liver, myocardium and adrenal glands, the pathology picture characterizes the inflammatory process in the organ.

How is a fat embolism treated?

Before hospital treatment for a fat embolism is started, the doctor can take steps to manage the complications. During extensive injuries, there is a high risk of blockage of blood vessels by fatty particles. Physicians must take measures to prevent a dangerous condition.

It is important to react in such situations:

decrease in blood pressure for a long time;
traumatic shock;
crushed thighs, shins and pelvic bones;
delay in hospitalization of the victim;
illiterate immobilization.

Fat embolism must be treated in a hospital setting

First aid to the victim in case of injuries - immobilization of the injured limbs, preventing rupture of the tissues surrounding the broken bone. To prevent traumatic shock put painkillers. After the first aid is competently provided, the victim is transported to the traumatology. If necessary, in the ambulance, respiratory support is provided, corticosteroids are administered, and deep vein thrombus prophylaxis is carried out.

When a fat embolism is diagnosed, treatment is carried out in intensive care or in a hospital - it all depends on the severity of the damage, the presence of concomitant diseases and complications. Doctors have at their disposal a number of medicines and procedures designed to improve the blood supply to tissues in the injured area of the body and stabilize the condition of the victim:

ventilation of the lungs is carried out when identifying mental abnormalities, confusion. The procedure is carried out until consciousness is restored, and the patient's condition stabilizes. Even if a person does not have a symptom of respiratory failure, a disturbed acid-base balance indicates the need for lung ventilation;
introduction of demulsifiers. These substances dissolve fats in the blood, transforming large particles into small ones. This will prevent clogging of blood vessels with fats. Thanks to the drugs Decholin, Essentiale, the lipid composition in the blood is normalized;
heparin therapy, the introduction of frozen plasma and fibrinolysin inhibits the development of DIC;
plasmapheresis;
diuresis with sodium hypochlorite;
surgical intervention;
the use of corticosteroid hormones is designed to protect tissues from the effects of harmful substances and enzymes, improve the stability of the blood-brain barrier, and restore membranes. To prevent pneumonia, Prednisolone, Dexamethasone are prescribed;
antioxidants reduce the effect of toxins on organ cells;
antibiotics are prescribed to prevent complications, inflammatory processes;
therapeutic nutrition with amino acids, microelements, vitamins, glucose, insulin is aimed at improving the condition of the victim, accelerating rehabilitation after injury.

Not to be missed possible development For a fat embolism, health workers monitor the patient for 24 hours, monitoring pressure and other indicators of the condition. All medical manipulations are carried out carefully.

Prevention

In case of damage as a result of accidents and industrial injuries, other situations, it is necessary to immediately provide competent assistance to the victim. It is important not to miss the time, since the risk of fat embolism occurs in the first three days, you can not be afraid of such a complication. Transportation of the victim to the intensive care unit is carried out after it is possible to bring him out of a state of shock. A prerequisite is the immobilization bandage. The collection and movement of bone fragments is carried out after removal of the hematoma.

For complex fractures of tubular bones, the method of open osteosynthesis is recommended. If you can not do without surgery, it is carried out as soon as possible, trying to reduce injuries. Medicinal liquids are injected into the vein only through a dropper.

With TBI, the diagnosis of embolism is difficult, so the victim is under the control of a neurologist, who notes the slightest changes in the condition.

Summing up, it can be noted that fat embolism is a dangerous pathology that occurs when the body is damaged - burns, fractures and other injuries. To avoid the problem, you need to take possible measures to reduce the risk of injury.

Whatever the injury: a cut, a fracture, or an ordinary scratch, the human body perceives it as a colossal stress. After all, he needs to do everything so that the blood does not flow out, no infection gets into the wound, and also protect the body from all sorts of dangers of the environment.

But the most unpleasant situation can be when the injury was mild, but its consequences turned out to be really terrifying. One of these consequences is a fat embolism, in which the body harms itself by creating blood clots.

What is it?

In medicine, fat embolism refers to any pathological process in which without fail fat cells may appear in the blood. The slightest amount of fat in the vessel can lead to disastrous consequences.

Like a blood clot that leads to a heart attack and stroke, fat, moving through the human venous or arterial system, clogs the vital ducts. It also creates a life-threatening situation.

Usually, with such clinical pictures, the following factors of the onset of the disease can be detected in patients:

large blood loss;
dizziness;
overweight;
nausea.

In the international classification, this disease can be categorized as T79.1. With delayed surgery, fat embolism can be repeated several times.

In what forms does it appear?

This disease has several main forms, the most common in modern medical practice:

lightning embolism - this type is one of the most dangerous forms, because it is almost impossible to save the patient due to the fact that the development of a fat embolism occurs in a matter of minutes, and it takes much more time to determine it;
acute embolism - development begins to occur within 2-3 hours after the patient receives an injury, and continues for 1-2 days. It occurs more often than other forms;
subacute embolism - development occurs from a day to 3 days after a person is injured. One of the most favorable forms of disease development.

How is it classified?

According to the conditional classification, depending on the manifestations, fat embolism is pulmonary, cerebral or mixed. And also it can be divided, depending on the foci, into cerebral embolism, pulmonary embolism, with development in the liver.

Among other things, it is also classified according to the reasons due to which it could arise. This can occur during surgery or after amputation of limbs, during open fractures, surgical interventions, and even due to improper medical treatment.

To date, doctors have only a couple of theories at their disposal and a lot of speculation about how it appears and what are the reasons for the development of fat embolism. All this is further complicated by the fact that two main types are distinguished - mechanical and biochemical embolism, with a corresponding, characteristic, onset of the disease.

According to the first theory, increased bone marrow pressure during trauma and surgery may be the main cause of fat embolism. It is because of this that fat cells penetrate into the patient's blood vessels, where, by binding to platelets or ordinary blood cells, they can form a microthrombus, which will go further through the bloodstream.

In the worst cases, such blood clots reach the brain or heart, clogging, for example, valves in the latter. Under more favorable circumstances, they gradually fall apart on their own, but this does not happen so often.

biochemical theory

According to the biochemical theory, cell injuries leading to fat embolism occur due to changes in the endocrine system and, accordingly, the hormonal background of the patient. If at the same time the hormonal imbalance will take place at the same time as sepsis, then the penetration of lipoprotein bodies into the blood becomes extremely likely.

Those, in turn, begin to cling to the vessels of the lungs, because of this, the bronchi and the blood ducts themselves are damaged, blood circulation is disturbed, respectively, and the chance of a fat embolism increases several times.

The cause of a fat embolism is trauma. But this pathology also occurs with various errors during surgery in the area of tubular bones.

Among other things, the pathology can also manifest itself against the background of such actions as: prosthetics, various closed fractures with internal bleeding and open fractures, respectively, as well as any intervention in the fatty layers, be it liposuction or plastic surgery on the dermis and lower epithelial layers.

And also the cause of a fat embolism can be not only an injury and an incorrectly performed operation, but also various intravenous drugs.

Such as corticosteroids or various fat emulsions. That is why it is worth making sure that when using steroids, it is the professional who injects the patient.

What are the symptoms?

One of the most dangerous aspects of this disease is that there may be no symptoms at all for several days. But the worsened condition of the patient is usually perceived by both the patient and the doctors themselves as a reaction of the body to the operation. Developing pathologies are manifested as follows:

increased heart rate;
increased breathing or lack of air;
various small hematomas and small red spots in the place where subcutaneous bleeding could occur;
a vague state of awareness, disorientation in space;
fever and intense thirst, turning into febrile attacks.

Patients usually complain of increased fatigue, and often there are migraines and pain in the heart, and with high blood pressure severe dizziness may occur. Tellingly, other symptoms are easily confused with a microstroke or microinfarction, which are already the consequences of this disease.

It is precisely the fact that it is extremely difficult to diagnose and makes fat embolism a very dangerous disease, especially when it comes to fat accumulations in the lungs, when the patient complains of rapid breathing.

How is it diagnosed?

All that is present in the primary diagnosis is an analysis of the anamnesis of the general symptoms of the disease. The whole picture is very similar with strokes and heart attacks in a milder form, so this can be both a problem with the central nervous system and other symptoms.

One of the most serious and rare manifestations is the patient's entry into a coma, while there may not be any prerequisites for this at all. Before an exacerbation, a person will look completely healthy, and his condition may even improve if an operation has been performed.

If, during the initial diagnosis, the appearance of a pulmonary embolism or some other type was suspected, then the doctors refer the patient for an additional examination:

a general analysis of urine and blood, with which you can cover the largest number of possible diseases, including fat embolism;
a biochemical blood test, which is performed with specific suspicions and in the case when this disease is not associated with injuries;
x-ray of the cranium, due to which blockage of cerebral vessels and subsequent hemorrhages can be excluded;
other studies that would allow us to exclude diseases similar in symptoms (of which there are actually quite a lot);
MRI, which will identify the focus of inflammation and determine the causes of its occurrence.

But what to do when the doctor has made a diagnosis? How to treat an embolism and prevent life-threatening complications?

How is an MRI performed?

How is the treatment going?

Under no circumstances should an embolism be treated with folk remedies, which stimulates its development. This disease is too dangerous and difficult for such activities, the usual blood-thinning solutions do not help the patient.

Initially, the patient undergoes conventional therapy, the course of which must necessarily include oxygen therapy using nasal catheters. If it was not possible to identify the pathology in time, this method of treatment is ineffective, a waste of precious time for the patient.

If conventional therapy has not yielded any results, respiratory therapy is started, in which they try to keep the oxygen pressure in the vessels at a high level. All this only allows you to save a person's life for a little longer and keep the patient in a stable condition. But after all these enterprises, drug therapy is mandatory to be carried out to eliminate the blood clot.

Here, there may already be several methods of treatment, depending on whether doctors are dealing with a pulmonary embolism, or with another form of the disease. And also depending on general rules clinics and approved drugs in certain countries.

Fat embolism is an extremely dangerous and difficult to detect disease, fortunately, according to statistics, with symptoms, the disease manifests itself quite rarely. But it is worth remembering that the most common is a fat embolism in a fracture, so appropriate tests should be carried out to identify this disease.

How long it takes for treatment can only be determined by doctors, it all depends on what signs the patient has. Treatment of fat embolism in fractures takes place in stages. If detected in time, it is quite harmless, however, in a neglected state, it can cause a lot of trouble and lead to disastrous consequences.

Video: Fat embolism syndrome

Each person is prone to the appearance of injuries to the bones of the skeleton. Each of them requires immediate treatment, otherwise the development of complications is not excluded. One of these pathologies is fat embolism, which has its own specific features, varieties and methods of therapy.

Etymology of the disease

What is a fat embolism? The disease is a pathology associated with the penetration of fats into blood cells. The main cause of the development of the disease is considered to be trauma. bone tissue especially in patients with increased blood loss or excessive body weight.

Medical specialists distinguish several varieties of this disease, and each form occurs depending on the course of the pathology:

fulminant - characterized by rapid development, and the process itself takes about several minutes, resulting in a fatal outcome;
acute - spread occurs within a few hours after injury;
subacute - more than one day is spent on development.

There is also a conditional division of the disease into groups, while the patient can be diagnosed with pulmonary, cerebral or mixed fat embolism. In most cases, fats have a negative effect on the area of the brain, lungs and liver. On other internal organs, the impact of the disease is much less common.

Origin factors

Fat embolism syndrome can develop due to the influence of certain kinds of factors. Medical professionals tend to hold two theories as to what the causes might be.

The first theory implies that the formation of the disease is associated with an increase in pressure in the bone marrow after injury or as a result of surgery. After the penetration of fat cells into the blood, the formation of the so-called microthrombus occurs, which subsequently moves throughout the entire body area. The second is biochemical. What it is? She says that a violation at the cellular level is directly related to a negative change in the hormonal background of the human body.

Simultaneously with this factor, sepsis can occur, which provokes a violation of the proper movement of blood.

Additional factors affecting the development of the disease include:

a surgical procedure to remove excess fat;
closed bone fractures;
prosthetics of the hip joint;
receiving severe burns of a large area of \u200b\u200bthe skin;
bone marrow biopsy;
diagnosing concomitant diseases, for example, osteomyelitis or acute pancreatitis.

In some and very rare cases, factors that are not associated with injury to individual parts of the body can affect the fat embolism syndrome.

Symptomatic manifestations

Thromboembolism is a rather serious disease, not only because it develops relatively actively and can be fatal in a minimum period of time, but also because it does not show any visible symptomatic signs at the initial stages of its development. The primary symptom of the disease is the occurrence of pain, but patients attribute this to the consequences of injury or surgical treatment. After the development of the disease reaches the optimal point, symptoms begin to appear.

The most common include:

cardiopalmus;
active respiratory process;
the formation of redness of a small size in those places where bleeding of small vessels occurs;
disturbance of consciousness;
the appearance of fever.

The patient may experience a constant feeling of fatigue, accompanied by headaches, dizziness, or pain in the sternum.

If the disease is formed due to the influence of the above factors, then the symptomatic signs have a slightly different nature of manifestation. In this case, the patient has a violation of the central nervous system, headaches have the nature of attacks in relation to their manifestation, the patient loses the ability to adequately respond to the surrounding reality. Often, the patient may be tormented by a cough, and when sputum is separated, blood blotches may be observed in it. In the process of all symptomatic manifestations, the respiratory process begins to noticeably weaken, which provokes the formation of the so-called fine bubbling rales. In almost all cases, the patient's body temperature actively rises almost to the maximum mark, while taking antipyretic drugs does not give positive results.

Diagnostic measures and methods of treatment

First of all, when diagnosing this disease, a thorough study of the patient's sting regarding the manifestation of symptomatic signs is carried out. After that, the patient is sent to conduct a certain series of studies in order to confirm or refute the alleged diagnosis. These activities include:

a laboratory study of a general blood and urine test in order to study the general condition of the patient's body and the presence of concomitant diseases;
a biochemical blood test to detect an indirect cause of the disease;
computed tomography of the skull to examine and identify possible negative violations;
radiography.

Magnetic resonance therapy is considered the most functional and effective, since it can be used to identify main reason occurrence of the disease.

Once the diagnosis is confirmed, the treatment of a fat embolism first begins with the supply of necessary quantity oxygen region of the brain. The following therapeutic measures are divided into:

Therapeutic. They include treatment with oxygen, but over time, this method has lost its increased effectiveness, since the disease is not always detected on time. After that, the patient requires respiratory therapy.
Medical. The standard form of treatment for the disease involves the use of sedatives simultaneously with artificial ventilation of the lungs (used, as a rule, when severe cerebral disorders are detected). This also adds the intake of analgesic drugs to normalize body temperature and broad-spectrum antibiotics. Some medical specialists argue that at the moment it is necessary to use methylprednisolone or prednisolone, as they help to stop the development of the disease. If necessary, diuretics can be included in the use in order to reduce the accumulation of fluid in the lungs.

Carrying out therapeutic measures should be timely, since the disease is capable of leading the patient to death in a minimum time period.

Preventive actions

Preventive measures undoubtedly play an important role, especially for those patients who are prone to the occurrence of this kind of disease and are in the so-called risk group. These include patients who have relatively recently undergone surgical treatment or severely injured. All existing preventive measures regarding this problem imply that the patient receives appropriate and competent medical care in case of injury, normalizes the process of blood circulation and stops bleeding if it occurs, the correct transportation of the patient to the medical facility after injury, and, if necessary, the timely provision and conduct of initial therapeutic measures, the use of appropriate drugs and the implementation of constant monitoring of the general condition of the patient.

The duration of preventive measures, as a rule, is of the order of several days after the surgical treatment has been carried out or the injury has been received.

Without fail, the patient must be aware of possible subsequent complications. Thromboembolism associated with blockage in itself is a complication process, for this reason it is considered a rather dangerous pathology. Even if the patient is provided with highly qualified medical care, and at the same time timely, this does not at all mean that the blood supply remains normal. All these consequences negatively affect the functionality of the body as a whole, as it provokes the active emergence and impact on the body of numerous and diverse diseases of a chronic nature. Of course, death is considered the most serious and most common complication.

Thus, this disease is a serious threat to the life of the patient. The prognosis for the patient's future life depends on the quality and timeliness of treatment. Modern medicine has become a much improvement, as evidenced by the decrease in the number of cases when the disease ends in death. However, this factor is not always confirmed, since some forms of the disease can be difficult to diagnose.

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Cardiologist

Higher education:

Cardiologist

Kabardino-Balkarian State University them. HM. Berbekova, Faculty of Medicine (KBSU)

Level of education - Specialist

Additional education:

"Cardiology"

State Educational Institution "Institute for the Improvement of Doctors" of the Ministry of Health and Social Development of Chuvashia

Trauma is a serious shock to the body. It can undermine health and provoke severe complications. One of them is fat embolism. Usually, such a pathology manifests itself in overweight injured patients with significant blood loss. Experts note: if therapeutic measures are not taken in time, the possibility of recurrence of fat embolism increases several times.

Fat embolism: features of the pathology

Fat embolism is a consequence of an injury that provoked the formation of blood clots in the form of fat particles in the vessels of the circulatory system. Pathology is most often caused by damage to the ribs and pelvic bones. The use of a variety of orthopedic fixators only increases the possibility of the formation of fat emboli. The first impetus to the progression of fat embolism is the negative changes in the properties of the blood, which disrupt blood circulation in small vessels.

Pathology manifests itself against the background of oxygen deficiency and a decrease in the volume of circulating blood. Blood vessels and corresponding organs are filled with fat particles, which over time are grouped into microthrombi. Lipid metabolism products and enzymes have a toxic effect on the body. The membranes of the vessels and lungs are injured, sometimes causing DIC (a violation of blood clotting due to a significant release of thromboplastic substances from the tissues).

The course of fat embolism is greatly influenced by disturbances in the structure of erythrocytes. In pathology, among normal red blood cells, their altered forms (in the form of sickles, spikes, balls) or red blood cells of unnaturally small sizes are observed. Their number depends on the severity of the injury and its consequences. In accordance with the clinical picture of development, several forms of pathology are distinguished:

pulmonary;
cerebral;
mixed.

In addition, fat embolisms are subdivided according to the duration of the course. They can be:

lightning fast (sudden death);
acute (occur in the first hours after injury);
subacute (death within a three-day period).

Reasons for the development of pathology

There are four versions of the occurrence of fat embolism:

classical - fragments of fat from the injured focus enter the passages of the veins and with blood - into the pulmonary vessels, blocking their gaps;
enzymatic - in case of injury, fatty substances in the blood under the influence of an enzyme (lipase) are transformed from a dispersed state into drops, negatively affecting surface tension. Fragments of fat from the bone marrow activate the secretion of lipase, which contributes to the further development of the process;
colloid-chemical - fatty substances in the blood are transformed from emulsion particles into drops under the influence of the injury itself;
hypercoagulation - a complex of post-traumatic disorders leads to the development of blood clotting disorders due to an imbalance in lipid metabolism.

In 90% of cases, the progression of the pathology is provoked by skeletal injuries, more often these are damage to large tubular bones. The likelihood of manifestations of fat embolism increases with multiple fractures. Rarer causes of the development of pathology include:

connection of fragments of the thigh bones with large pins;
replacement of worn-out tissue of the hip joint with artificial endoprostheses;
closed reduction of displaced bone fragments;
massive surgical interventions for lesions of tubular bones;
significant injury to soft tissues;
severe burns;
surgical correction of the figure;
taking a bone marrow sample;
excessive accumulation of fats in the liver;
prolonged treatment with corticosteroids;
acute inflammation of the pancreas;
inflammation of the bone marrow;
introduction of fat emulsions.

Symptoms of a fat embolism

Fat embolism is able to "mimic" - the beginning of the formation of fat droplets in the blood is not accompanied by symptoms. Gradually, they group and clog vessels of various sizes. Symptoms of a dangerous condition will appear when fat emboli “occupy” a significant part of the blood vessels. This usually happens within one or two days. Fat drops provoke ruptures of blood vessels, which is manifested by hemorrhages - more often in the upper chest and in the armpits. After this obvious symptom, others appear:

significant shortness of breath;
cough;
rapid heartbeat;
"bloodshot" eyes, pain in the sockets;
cyanosis of the skin;
fever;
loss of consciousness.

Fat drops are able to move with the blood flow (mobile), and can be fixedly attached to the wall of a certain vessel (immobile). If the embolus is mobile, the pathology develops in a few hours. Its manifestations depend on the organ affected by the embolus. For example, if a drop of fat clogs a coronary vessel, heart failure and cardiac arrest occur. If the embolus has penetrated the vessels of the kidneys, the fat embolism will cause their insufficiency. And if a drop of fat clogged the cerebral artery, a stroke or cerebral infarction develops.

In accordance with the localization of emboli, the pathology is expressed:

Disorders of the central nervous system:

headache;
disorders of consciousness and psyche;
paralysis and paresis;
delusional states;
weak manifestations of clinical signs of irritation of the meninges;
pendulum eye movements;
violations of the pyramidal cells of the cerebral cortex;
muscle twitching;
coma;

Breathing disorders:

chest pains;
wet cough with blood clots;
severe shortness of breath;
bubble wheezing;
sustained tachycardia;

Permeability and fragility of capillaries (reddish rash in the mouth, conjunctiva, cheeks, neck, shoulders, chest, back);
Heat (up to 40 ° C).

With a febrile sign of fat embolism, antipyretic drugs are ineffective, since cerebral thermoregulation is impaired by fatty acids.

Features of pathology in heart diseases

The negative impact of fat embolism on the state of blood vessels is undoubted. But it also affects the activity of the heart muscle. Blockage in heart disease a large number small vessels of the pulmonary circulation does not give the weak organ the opportunity to overcome the obstacles to blood flow that have arisen. Are being created ideal conditions for the expansion of the heart and its paralysis - this can happen before the heart contractions push the fat droplets into the vessels of the systemic circulation of blood.

In case of damage to the coronary vessels, at autopsy in the areas of myocardial blockage, lesions of different sizes are noticeable, sometimes bordered by leukocytes. This condition is called "tiger" heart. At the same time, noticeable:

breakdown of myocardial muscle fibers into separate fragments;
hemorrhages in the conduction system of the heart muscle;
retrograde venous embolism.

Fat emboli move along the cardiac veins not only due to a sharp increase in pressure in the right sections of the heart muscle, but also due to a drop in pressure in the coronary arteries. Contribute to the promotion of fat and Viessen vessels that communicate with the right side of the heart. Experts believe that when determining the risk of fat embolism, reflex convulsive phenomena are important due to lung irritations and their transmission to other organs, including the heart.

Pulmonary insufficiency can cause heart failure - fatty substances in the blood of the pulmonary circulation increase its viscosity and create resistance to the work of the right sections of the heart muscle. The reverse side of these phenomena is insufficient filling of the left heart with blood and oxygen starvation of the myocardium. Such facts indicate that heart failure always plays a large role in fat embolism, and the leading role in coronary artery embolism.

Diagnosis of a fat embolism

Diagnosis of fat embolism is usually carried out on the basis of clinical data. Laboratory studies are of secondary importance. The diagnosis is confirmed if the patient has several disorders at the same time:

rounded whitish spots near the vessels of the eyes, edematous retina;
tachycardia over 90 beats per minute;
body temperature above 38°C;
signs of shock lung syndrome (shortness of breath, anxiety, palpitations);
change of consciousness;
low amount of urine excreted by the kidneys;
fat droplets with a diameter of about 6 microns; microscopic cylindrical bodies from coagulated protein, blood cells, epithelium of the renal tubules (urinalysis);
anemia, signs of increased or decreased blood clotting (blood test);
diffuse infiltrate in the lungs (X-ray).

There are various scoring diagnostic methods, in which each criterion corresponds to a certain score. Their count allows you to determine the presence of latent and overt fat embolism.

Fat embolism therapy

Treatment activities include:

saturation of the body with oxygen;
lung ventilation;
stabilization of hemodynamics;
infusion of blood products according to clinical indications;
prevention of deep vein thrombosis.

Specific therapy for fat embolism is to provide body tissues with oxygen. Artificial lung ventilation (ALV) is carried out if the patient has impaired consciousness - he is overly excited, behaves inappropriately, and is not able to perceive speech. With such manifestations, mechanical ventilation is indicated even in the absence of manifestations of respiratory failure and violations of the acid-base balance. In the treatment of fat embolism, medicines, but their results are not convincing enough. Used drugs:

corticosteroids - to relieve inflammation, reduce hemorrhage and swelling;
Aspirin - to normalize blood gases, coagulate proteins and platelets;
Heparin - to stimulate lipase activity. But it can be potentially dangerous if an increase in free fatty acids is part of the pathogenesis. In addition, there is the possibility of an increased risk of bleeding in patients with multiple injuries;
N-acetylcysteine;
Lipostabil and Essentiale - to restore the physiological dissolution of demulsified fat.

forced diuresis (increased volume of urine produced);
plasmapheresis (blood sampling, purification and return to the bloodstream);
ultraviolet and laser irradiation of blood.

Intensive care aims to maintain and restore the basic functions of the body, is symptomatic. Surgery is indicated to stabilize bone fractures. If possible, the most sparing method is used - using rod devices.

Prevention of pathology

Measures to prevent fat embolism in patients who have undergone massive trauma or surgical therapy include:

carrying out adequate medical measures in case of injury;
replenishment of blood loss and elimination of bleeding;
correct fixation of the affected parts of the patient's body (pneumatic tires);
competent transportation of the patient to a medical facility;
the implementation of early therapy aimed at slowing platelet aggregation;
taking drugs that help normalize lipid metabolism;
monitoring the patient's condition.

Prophylaxis continues three to four days after injury or surgery.

Fat embolism is initially dangerous, because in itself it is a complication of existing pathologies. Even with qualified therapy, it can disrupt blood flow and affect the state of the whole organism, and in case of exacerbation of chronic diseases, it can provoke a fatal outcome. Modern diagnostic methods have significantly reduced the mortality rate in case of fat embolism, but the prognosis remains unfavorable.