FEATURE ANAESTHESIOLOGY


the use of pneumatic tourniquet, there have been reports of FES associated with total knee replacement, especially bilateral total knee replacement. Femoral reaming, femoral shaft osteotomy and intraosseous injection have been associated with FES.


TREATMENT The first steps in the treatment of fat embolism are to minimize the clinical factors that are mobilizing fat, such as manipulation of fractures, reaming of a medullary canal and lack of immobilization of a long bone fracture. Survival depends on support of the cardiovascular system for a patient in acute, right heart failure. Support of the circulation starts with aggressive volume support, because of the hypovolemia that results from massive edema and capillary leakage. Use of central venous pressure can guide inotropic support of the cardiac output. Pulmonary artery catheter placement may be necessary if respiratory failure requires high levels of positive end-expiratory ventilatory


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Arab Health Congress 2012 will feature the return of the Middle East Interventional Cardiovascular conference on 26th January. The conference will focus on providing the delegates with an educational platform to underline the latest updates and improvements in the field of vascular medicine. To register to attend on-site, visit the Al Wasl foyer between halls 4 and 5.


pressure (PEEP), requiring serial cardiac output determinations to guide inotropic support. Since FES involves inflammatory injury to the lung and other tissues, high dose steroids may be indicated. The CNS injuries unfortunately


have limited treatment options. Seizure activity should be suppressed. Aggressive treatment of increased ICP indicated, with diuresis and hyperventilation. If elevated ICP or seizures occur, the prognosis is grave. Either of these consequences can be


an indication to secure the airway. Support of the respiratory system is


critical for survival of severe FES because of the profound, acute insult. If supportive measures can sustain the patient without CNS or cardiac damage, the potential for healing of the injury and return to normal function is high. The goal is adequate oxygenation, particularly the myocardium, the CNS and other end-organs. Optimum support of the cardiac output is required with titration of ventilation to accomplish satisfactory oxygen delivery with the lowest possible inspired oxygen concentration. Optimum PEEP, pressure support ventilation, adequate cardiac output and effective sedation are important. High inspired pressures due to patient agitation will further aggravate lung injury. Thrombocytopenia must be treated with platelets, decreased labile clotting factors with fresh frozen plasma (FFP) and decreased fibrin levels with pooled cryoprecipitate. Point of care testing with thromboelastogram or sonoclot devices can guide treatment of DIC. ■


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