ABSTRACT
Early diagnosis of cerebral fat embolism in a patient with contradiction to MRI is challenging. Here we report an interesting case, where the raised optic nerve sheath diameter helped us to predict the early cerebral involvement with fat emboli in a left femoral shaft fracture patient. MRI scan could not be performed due to the presence of a metallic implant in the patient from a previous surgery. He was later diagnosed as an atypical presentation of fat embolism syndrome. Optic nerve sheath monitoring also helped us to guide further management of the patient.
ABSTRACT
PURPOSE@#Fat embolism syndrome (FES) is systemic manifestation of fat emboli in the circulation seen mostly after long bone fractures. FES is considered a lethal complication of trauma. There are various case reports and series describing FES. Here we describe the clinical characteristics, management in ICU and outcome of these patients in level I trauma center in a span of 6 months.@*METHODS@#In this prospective study, analysis of all the patients with FES admitted in our polytrauma intensive care unit (ICU) of level I trauma center over a period of 6 months (from August 2017 to January 2018) was done. Demographic data, clinical features, management in ICU and outcome were analyzed.@*RESULTS@#We admitted 10 cases of FES. The mean age of patients was 31.2 years. The mean duration from time of injury to onset of symptoms was 56 h. All patients presented with hypoxemia and petechiae but central nervous system symptoms were present in 70% of patients. The mean duration of mechanical ventilation was 11.7 days and the mean length of ICU stay was 14.7 days. There was excellent recovery among patients with no neurological deficit.@*CONCLUSION@#FES is considered a lethal complication of trauma but timely management can result in favorable outcome. FES can occur even after fixation of the fracture. Hypoxia is the most common and earliest feature of FES followed by CNS manifestations. Any patient presenting with such symptoms should raise the suspicion of FES and mandate early ICU referral.
Subject(s)
Adolescent , Adult , Humans , Male , Young Adult , Central Nervous System Diseases , Early Diagnosis , Embolism, Fat , Diagnosis , Fractures, Bone , Hypoxia , Intensive Care Units , Length of Stay , Patient Outcome Assessment , Time Factors , Trauma CentersABSTRACT
Hemophilia A is a congenital bleeding disorder with low factor VIII levels in the blood. We report the anesthetic management of a hemophilic patient presenting with trauma in the left forearm. Patient received Factor VIII perioperatively with no excessive blood loss intraoperatively. We stress that adequate preoperative preparation and a planned anesthesia leads to a successful management of hemophilic patients
ABSTRACT
Though the condition Eisenmenger syndrome [ES] is quite rare, the patients may present for incidental surgeries. The anesthetic management is quite daunting in such patients since the physiological changes occurring during anesthesia may adversely affect the shunt. The perioperative mortality is quite high and ranges from 4% to 30%. The choice of anesthesia remains a controversial subject and the best technique is still not defined. We herein report a 23 year old male patient who was a known case of ES scheduled to undergo inguinal hernia repair. We planned the surgery under local anesthetic infiltration at the site and ilioinguinal nerve block. However the desired effect of local anesthetics was not obtained and the further anesthetic management of the patient was very challenging task