A person with multiple injuries develops fever, restlessness, tachycardia, tachypnea and periumbilical rash. The likely diagnosis is:
Ans. is 'b' i.e. Fat embolism The classical picture of mental disturbances, tachycardia, tachypnea and periumbilical rash in a multiple injury patient suggests a diagnosis of fat embolism.Fat embolism is a common phenomenon after fractures of long bones. In most instances, fat embolism is clinically inapparent. A small percentage of these patients develop clinical features similar to those of ARDS known as Fat Embolism syndrome.The source of fat emboli is probably the bone marrow, and the condition is more commonly seen in patients with multiple fractures.Symptoms are evident 1 to 3 days after the injury, and includes slight rise in temperature, increased pulse rate, breathlessness, mild mental confusion or restlessness and petechiae. In its most severe form, which may be fatal, this syndrome is characterized by respiratory failure, mental changes deteriorating to coma, thrombocytopenia, and widespread petechiae.Diagnosis:In a case with multiple fractures, early diagnosis may be possible by strong suspicion. In addition to the classis clinical features, signs of retinal artery emboli may be present. Sputum and urine may reveal the presence of fat globules.Chest x-rays reveal diffuse opacity of the lungs, which may progress to a "whiteout" typical of acute respiratory distress syndrome.Low blood P02 values may indicate respiratory failure.Management:Severe fat embolism syndrome can probably be avoided by the use of high doses of oxygen immediately after injury and by the prompt stabilization of long-bone fractures.In mild cases, treatment is supportive with high inspired oxygen tensions supplemented if necessary by mechanical ventilation.In severe cases recovery is unpredictable and the mortality rate high.Air embolism can cause similar clinical picture but is rarely seen after trauma.Causes of air embolism are:The primary cause of venous air embolism is surgical procedures, especially neurosurgical procedures performed in the upright, sitting position. Anytime the operative site is more than 5 cm above the right atrium, VAE is a risk. Other surgical procedures that can lead to the infusion of air include obstetric/gynecologic procedures (cesarean section), craniofacial surgery, dental implant surgery, vascular procedures, liver transplantation, and orthopedic procedures (eg, hip replacement, arthroscopy). The frequency of reported VAE in surgical procedures ranges from 10% in cervical laminectomy up to 80% in posterior fossa surgery.Iatrogenic creation of a pressure gradient for air entry. Eg. Spinal needles in lumbar punctures (case report), peripheral intravenous lines, central venous catheters etc.Mechanical insufflation or infusion as during arthroscopic procedures, CO2 hysteroscopy, laparoscopy, urethral insufflation, and orogenital sexual activity during pregnancy.Positive-pressure ventilation, which can occur during mechanical ventilation and SCUBA diving.Blunt and penetrating trauma to the chest, abdomen, neck, and face can lead to the entry of air and ultimately to VAE.Small amounts of air do not produce symptoms because the air is broken up and absorbed from the circulation. Although classical teaching states that more than 5 mL/kg of air (IV) is required for significant injury (including shock and cardiac arrest), patient complications secondary to as little as 20 mL of air (the length of an unprimed IV infusion set) have been reported. Further, as little as 0.5 mL of air in the left anterior descending coronary artery has been shown to lead to ventricular fibrillation.
Air embolism
Fat embolism
Pulmonary embolism
Bacterial pneumonitis
Complications In  Orthopedics