drems
Forum Newbie
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a 19y.o man has sudden onset of SOB & confusion 36hrs after admission in the hosp for injuries sustained in a motor vehicle collision.he underwent placement of an external fixator device for fractures of the left tibia and fibula. Current meds include morphine.
he is not oriented to TPP. His vitals
T-102.4F
P-110/min
R-26/min
BP-110/50mmHg
Pulse oximetry on room air shows Oxygen Sat. of 87%.On exam, there are petichiae o n shoulders, chest and axillae. No evidence of bleeding in lower extremities. What's most appropiate next step in Dx?
A. Measurement of fat in stool
B. Measurement of fat in urine
C. Measurement of serum lipase activity
D. X-ray of Chest
E. Peticiae biopsy
please, explain your answers. thanks!
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| GOGETA
Trying to get in PGY1
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That seems to be fat embolism I would go with D
something is telling me about Lipase, but lipase will be elevated anyway in trauma.
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| jmkhanzada
Forum Junior
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i would go with B......... although it is not specific...test but fat globules are present in urine...... none of other test click my mind..........
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| nightflight1945
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B. Measurement of fat in urine
It is the case of fat embolism and in fat embolism you can confirm the Dx by finding fat droplets in Urine exam or in fundoscopic exam you can see fat droplets in retinal vessels.
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| ngaybinhyen
Forum Guru
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Cool, thanks 
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| movado
Forum Newbie
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But urinary fat stains are not felt to be sensitive or specific enough for diagnosing fat embolism or for detecting a risk of it.
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| funnybone
Forum Newbie
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Since his Oxygen saturation has fallen to 87% wouldn't the best first test be an x-ray?
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| zx_stien
Forum Senior
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in this case i would do Xray first, i thought this way, ( i did UA or whatever fat globules) it was negative ( just saying) ... what am i supposed to do next????
so i think in this case the best INITIAL test is CXR
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| ngaybinhyen
Forum Guru
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drems, do you have the answer for this?
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| kpmle2
Forum Guru
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D. X-ray of Chest .
pneumonia –---- dyspnea, tachypnea, low saturations
septic ----tachycardia, hypotension, fever.
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| drfax
Forum Elite
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Posts: 258
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fat embolism
D. CXR (snowstorm-like appearance)
urine output for fat is not diagnostic
ref.
Sabiston 2004
Washington Manual
ACS 2006
FA Surgery Clerkship
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