The fat embolism syndrome.

The fat embolism syndrome is a symptom complex of acute respiratory failure after long-bone fractures. It is thought to be caused by deposition of embolic fat within the pulmonary capillaries, resulting in a capillary leak within the lung. The source of the embolic fat appears to be marrow fat. Alterations in circulating free fatty acids, increases in fibrin split products, and increases in platelet adhesiveness have been observed to occur in this syndrome and probably play an important part in the production of the pulmonary lesion. The signs and symptoms of the syndrome are hypoxemia, tachypnea, petechiae, fever, altered sensorium, and chest roentgenograms similar to signs of the adult respiratory distress syndrome (ARDS). Early recognition is facilitated by monitoring of arterial blood gas levels for hypoxemia. Treatment is directed at ARDS using graduated oxygen therapy and steroids.