Fat embolism syndrome (FES) is a clinical syndrome characterized by signs and symptoms resulting from fat emboli and typically occurs after trauma, orthopaedic surgeries and non-traumatic conditions like acute pancreatitis. Literature reports an incidence of FES of up to 19% in prospective studies. Fat embolism refers to the presence of fat globules in pulmonary microcirculation and is often asymptomatic. The clinical syndrome of FES is characterized by systemic manifestations resulting from fat emboli which may manifest with a triad of lung, brain, and skin involvement in about 24–72 hours of asymptomatic period. The pathophysiology of fat embolism syndrome remains unclear. Two theories have been hypothesized: mechanical(disruptive) and biochemical(production of toxic metabolites). Universal agreement on the definition of FES is lacking. FES presents with nonspecific signs and symptoms;common to other critical illnesses and is often a diagnosis of exclusion. The clinical criteria proposed by Gurd and Wilson are popular. Biochemical tests and imaging may be of value in supporting the diagnosis. Treatment for FES is essentially supportive care in ICU. Principles of treatment include maintenance of adequate oxygenation, ventilation, hemodynamics, and organ perfusion. It may be prevented by early fixation of large bone fractures.
Part of the book: Intensive Care
Acute and chronic pain management during pregnancy, after delivery and even during lactation are challenging even for experienced physicians. This chapter intends to cover pregnancy-induced physiological changes in relation to pain conditions. It also covers the most common pain disorders in pregnancy and provides a comprehensive summary of the pharmacological and non-pharmacological options for pain management in pregnancy. Additionally, pain management in context of opioid abuse will also be covered, as high prevalence of opioid prescription is linked to the very poor maternal and fetal outcomes. The possibility of maternal opioid abuse and fetal opioid withdrawal should be known to all physicians, given its rising trends. Multimodal protocols and opioid sparing strategies are highly essential for safe pain management during pregnancy and have been discussed. This chapter is intended to be a fast and detailed review for residents, pain fellows, and physicians who seek pain control in pregnant women.
Part of the book: Pain Management in Special Circumstances