Shahi Anil, Niraula Biraj, Santyan Bir B, Kafle Nischal, Gaud Shivendra K, Gosain Dinesh, Gupta Manish, Kharel Avash, Khatri Mala
Chitwan Medical College, Tribhuvan University, Bharatpur, Nepal.
Ann Med Surg (Lond). 2024 May 6;86(8):4767-4771. doi: 10.1097/MS9.0000000000002133. eCollection 2024 Aug.
Fat embolism syndrome (FES) arises from the systemic effects of fat emboli in microcirculation. While sepsis is characterized by pathological, physiological, and metabolic abnormalities caused by infection. Septic shock is identified by elevated blood lactate (>2 mmol/l) and the need for vasopressors to maintain a mean arterial pressure of 65 mmHg or higher in the absence of hypovolemia.
This case report discusses the clinical course and treatment of a 50-year-old male involved in a road traffic accident resulting in polytrauma. The patient presented with multiple fractures, hemopneumothorax, lung contusions, and rib fractures. He was then stabilized following which fractures were reduced and managed operatively. Postoperatively, the patient developed FES with septic shock, manifested by altered consciousness, petechial rashes, and respiratory distress. He was managed with intubation, chest drainage, and a combination of antibiotics, anticoagulants, and vasoactive agents. A tracheostomy was performed due to respiratory insufficiency. Following 29 days in the SICU, the patient's condition was stabilized and shifted to the general ward for further management. He was discharged after 48 days, with a complete recovery and a 2-week follow-up. This case report depicts the challenges in the management of FES with septic shock following polytrauma.
This case report is a comprehensive overview of FES complicated with septic shock. It highlights the importance of supportive care as the primary treatment modality, incorporating various medical interventions. The successful outcome and complete recovery of the patient underline the significance of prolonged monitoring, wound care, and physiotherapy.
脂肪栓塞综合征（FES）源于微循环中脂肪栓子的全身效应。而脓毒症的特征是由感染引起的病理、生理和代谢异常。脓毒性休克的定义为血乳酸升高（>2 mmol/l），且在无血容量不足的情况下需要使用血管升压药来维持平均动脉压在65 mmHg或更高。
本病例报告讨论了一名50岁男性道路交通事故导致多发伤后的临床病程及治疗情况。患者出现多处骨折、血气胸、肺挫伤和肋骨骨折。随后病情稳定，骨折进行了复位并接受手术治疗。术后，患者发生了伴有脓毒性休克的FES，表现为意识改变、瘀点皮疹和呼吸窘迫。对其进行了气管插管、胸腔引流，并联合使用抗生素、抗凝剂和血管活性药物治疗。因呼吸功能不全进行了气管切开术。在外科重症监护病房（SICU）治疗29天后，患者病情稳定，转至普通病房进一步治疗。48天后出院，完全康复并进行了为期2周的随访。本病例报告描述了多发伤后伴有脓毒性休克的FES治疗中的挑战。
本病例报告全面概述了合并脓毒性休克的FES。它强调了支持性护理作为主要治疗方式的重要性，包括各种医学干预措施。患者的成功预后和完全康复突显了长期监测、伤口护理和物理治疗的重要性。
