Fat Embolism and Damage Control Orthopaedics
A young pedestrian was hit by a car and sustained Mid shaft of tibia fracture of her left leg. After 24 hours, he suffered from shortness of breath. Chest X-ray is shown as below. What may be the cause.
Fat Embolism in Pulmonary Artery
Upright portable AP chest x-ray showing hypovolemia secondary to a pulmonary embolism, knowns as Westermark sign. Image courtesy
https://emergencymedicinecases.com/wp-content/uploads/2012/03/015-15-Figure-1.jpg
Radiographic other findings
PA chest xray in a patient with a PE. Arrow denotes the area of pulmonary infarction, known as Hampton hump.
Image courtesy http://www.imagingpathways.health.wa.gov.au/images/pe/ham.jpg
Sometimes Atelectasis is found.
What is Damage Control Orthopaedics (DCO) ?
Planned and staged surgical strategy in management of polytrauma patients to minimize effects of second hit on already limited physiological response.
First Hit - from injury and body's response to this injury.
Second Hit - surgery
Studies suggest that primary ex-fixator and secondary nailing improves outcome. It decreases incidence of MODS and ARDS.
How to decide which patient requires DCO and what are its alternative ?
Alternative to DCO
-Early total care, early treatment of all fractures
DCO indications -
Injury Severity Scale (ISS)> 20
Abdominal or pelvic trauma in hypovolaemic shock (SBP < 90 mmHg)
Anyone with bilateral lung contusion
What is ISS ?
Based on Abbreviated Injury Scale (AIS)
Each body system gives on AIS of 1-6 with 6 most serious .
ISS is Dervied from adding squares of 3 most severely injured body system.
Score > 16 is considered injured.
When to expect to operate on a DCO ?
Made in conjunction with anaesthetist and intensivist.
Made in conjunction with anaesthetist and intensivist.
At least after four days.
BP, HR, T - Normal
ABG- Corrected
Convert Ex-fixator to a Nail in 10 days to avoid risk of fractures.
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