DrVirgo
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A 19 year old man has sudden onset of shortness of breath and confusion 36 hours after admission to the hospital for injuries from an MVA. He underwent placement of an external fixator device for open fractures of the left tibia and fibula. Current medications include morphine. he is not oriented to person, place or time. His temp is 102.4F, pulse is 110 reps are 26. PH is 100/50. Pulse ox. on room air shows an oxygen saturation of 88%. Examination shows petechiae on the shoulders, chest, and axillae. There is no evidence of bleeding in the lower extremities. Which of the following is the most appropriate next step in diagnosis?
A. Measurement of fat in stool
B. Measurement of fat in urine
C. Measurement of serum lipase activity
D. X-ray of the chest
E. Petechial biopsy
Whats the most likely diagnosis here?? What are we trying to look for?
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| hope4dabest
Forum Elite
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D....fat embolisim and we are trying to confirm it.......though it could also be B but i think after a trauma fat globules are seen in urin so i will say ANSWER IS D
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| hope4dabest
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By the way , "released " means these r some test questions ???????????????????
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| DrVirgo
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hope4dabest wrote:
By the way , "released " means these r some test questions ???????????????????
Yes.
Orientation and Practice Materials USMLE Step 1, Step 2 (CK and CS), and Step 3:
Click here for a menu to download:
[url=http://www.usmle.org/Orientation/2008/menu.html]2008]
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| DrVirgo
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Yes, it could be a fat embolism, agree.
But...
What are we looking for on CXR?
Why is it not B?
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| hero
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Chest radiography: Serial radiographs reveal increasing diffuse bilateral pulmonary infiltrates within 24-48 hours of onset of clinical findings.
Urine studies: Urinary fat stains are not felt to be sensitive or specific enough for diagnosing fat embolism or for detecting a risk of it.
Fat globules in the urine are common after trauma.
Medical care is supportive in nature and includes maintenance of adequate oxygenation and ventilation, stable hemodynamics, blood products as clinically indicated, hydration, prophylaxis of deep venous thrombosis and stress-related gastrointestinal bleeding, and nutrition.
Continuous pulse oximetry monitoring in at-risk patients (ie, those with long-bone fractures), may help in detecting desaturations early, allowing early oxygen therapy and possibly steroids, decreasing the chances of hypoxic insult and possible systemic complications of FES.
http://www.emedicine.com/med/TOPIC652.HTM
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| DrVirgo
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Thanks for the info! 
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| Sayulita
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Nice
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| Tuscani
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d!!!
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