Ebina Masatomo, Inoue Akira, Atsumi Takahiro, Ariyoshi Koichi
Department of Emergency Medicine Kobe City Medical Center General Hospital Kobe Japan.
Acute Med Surg. 2015 Jul 3;3(2):135-138. doi: 10.1002/ams2.127. eCollection 2016 Apr.
A 22-year-old man was injured in a traffic accident and developed respiratory distress on his first day of admission. On postadmission day 3, he developed serious respiratory distress with a suddenly altered mental status. Chest computed tomography revealed a pulmonary embolism that had not been evident when he was admitted. The patient was intubated and a continuous heparin infusion was started to treat the pulmonary embolism. Palpebral conjunctival petechiae were noticed the following day, at which point the patient fulfilled Gurd's criteria for fat embolism syndrome. Within a few days, his respiratory status was improved. Brain magnetic resonance imaging also provided evidence of fat embolism syndrome. His femoral shaft fracture was repaired on day 20.
The patient was discharged home on postadmission day 63.
Concomitant fat embolism syndrome and pulmonary embolism, although very rare, should be considered when a trauma patient's respiratory status worsens.
一名22岁男性在交通事故中受伤，入院第一天出现呼吸窘迫。入院后第3天，他出现严重呼吸窘迫，精神状态突然改变。胸部计算机断层扫描显示存在肺栓塞，入院时并不明显。患者接受了气管插管，并开始持续静脉输注肝素以治疗肺栓塞。次日发现睑结膜瘀点，此时患者符合Gurd脂肪栓塞综合征的标准。数天内，他的呼吸状况有所改善。脑部磁共振成像也提供了脂肪栓塞综合征的证据。他的股骨干骨折在第20天进行了修复。
患者在入院后第63天出院回家。
创伤患者呼吸状况恶化时，应考虑同时存在脂肪栓塞综合征和肺栓塞，尽管这种情况非常罕见。
