Fat and Amniotic Fluid Embolism

Expansion

Fat embolism syndrome

• Follows long bone or pelvic fracture, usually at 24 to 72 hours, and also orthopaedic surgery, pancreatitis and sickle crisis
• The triad: respiratory distress and hypoxia, neurological confusion and agitation, and a petechial rash over the upper trunk, axillae and conjunctivae
• The rash occurs in only about half but is close to specific
• Gurd’s criteria formalise the diagnosis
• Management is supportive, with early fracture fixation as the main preventive measure

Amniotic fluid embolism

• Occurs during labour, delivery or immediately postpartum
• Sudden cardiovascular collapse, hypoxia, seizures, then disseminated intravascular coagulation with massive haemorrhage
• Rare, but a leading direct cause of maternal death, with high mortality
• The mechanism is now understood as an anaphylactoid reaction to fetal antigen rather than mechanical obstruction, which is why it is sometimes called the anaphylactoid syndrome of pregnancy
• Management is supportive, with immediate resuscitation, delivery of the fetus, and aggressive treatment of the coagulopathy

Other non-thrombotic emboli: air (venous, needing a large volume, treated in the left lateral head down position), gas (decompression sickness), septic, tumour, cholesterol after vascular intervention, and foreign body.