Related disorders that occur in severe cranio-cerebral trauma - Fatty embolism

Patients with severe injuries of long bones especially at risk of developing disseminated cerebral embolism fatty. Fatty embolism can occur after politraumatisme with multiple fractures associated with damage to the blood vessels and tissue surrounding the fractured bone. This type of embolism is especially for femoral shaft fractures. Fatty embolism is caused by fat cells from bone marrow or chilomicronii that because the physico-chemical changes in blood levels (low lipid solubility), caused by trauma, suffering a large particle aggregation phenomenon. Fat globules reaching the systemic circulation at the fractured bone continuity solutions. Degradation of bone marrow fat have a toxic action on cell membranes. Following trauma-induced metabolic disorders, circulating triglycerides and glycerol will separate the fat, generating multiple circulating fat particles, and they attended the embolization.
Fatty emboli cause serious accidents depending on location:- Fatty embolism of the lung causing acute respiratory failure, emphasizing cerebral hypoxia. If the patient has lost consciousness after head trauma, and it is possible to lose from fatty pulmonary embolism, which also cause anxiety and sleepiness. Bronchopneumonia may occur rapidly after a fracture occurring in older patients.- The kidneys produce lipurie - removal of fat in the urine- Bleeding in the eye produce posterior pole and exudates- Sea level circulation cause purpura, neurological type injuries coma or hemiplegia. Disseminated intravascular coagulation may develop after an injury is caused by disturbances in the clotting mechanism.Also, initial symptoms may worsen polytrauma craniocerebral injury and can darken the prognosis, the exacerbation of existing diseases such as diabetes, retention of urine, lung, urinary infection, coronary insufficiency.
Evolution of fatty embolism clinic is: a few days after bone fracture, the patient accused a state of agitation, delirium, symptoms progress to drowsiness, seizures and even coma.
The CT scan or MRI (magnetic resonance imaging) may reveal the generalized cerebral edema and hypoxia. Also, CT and MRI can detect cerebral purple especially in the white matter, a phenomenon that occurs after occlusion of capillaries by fat particles.
Clinical examination reveals half of the patients point of retinal hemorrhages and conjunctival or retinal vessels fat bubbles. In the supraclavicular fossae and axillary envelope prior notice a petechial rash. The chest radiograph is simply objectifies diffuse interstitial pulmonary infiltrates. Urinalysis reveals that eliminate fat in the kidney. This can lead to the development of renal failure.
Treatment should begin before fatty embolism embolism to make manifest, or as soon as the first symptoms. Patients in whom treatment was instituted quickly have a better prognosis. The use of high doses of corticosteroids and positive pressure ventilation with high end-expiratory pressure.