342 Fat Embolism days. Patients with the classic form generally have a latent period of 1 to 2 days, followed by the development of symptoms that include mental status changes, shortness of breath, fever, tachycardia, and petechiae. The fulminant form is characterized by an early onset of neurological and respiratory deterioration, as well as the onset of signs of right ventricular failure (distended neck veins, liver congestion, peripheral edema). A rapid onset of neurological deterioration in patients who sustained severe injuries and multiple fractures but who were initially conscious suggests a fat embolism.

PHYSICAL EXAMINATION. The patient with a life-threatening fat embolism appears acutely ill with shortness of breath, rapid heart rate, and fever. The neurological examination may reveal confusion, agitation, or even stuporousness. Some patients may have a seizure. Note that neurological changes usually occur 6 to 12 hours before respiratory system changes and rarely without impending respiratory involvement.

Inspect the patient's skin for petechiae, a classic sign that appears 1 to 2 days after injury in more than half of patients with fat embolism. Petechiae are of short duration, last only 4 to 6 hours, and appear most commonly on the neck, upper trunk, conjunctivae, or retina. An ophthalmic examination may reveal fat globules in the retinal vessels. Approximately half of the patients who display neurological symptoms also develop microinfarcts of the retina. When you auscultate the patient's heart and lungs, you usually hear a rapid heart rate and rales, rhonchi, and possibly a pleural friction rub.

PSYCHOSOCIAL. Because fat embolism is a complication of other disease processes or traumatic injuries, the addition of another life-threatening complication could be the final breaking point for the family or significant others involved. Evaluate the patient's social network to determine what support is available during the acute illness.

Diagnostic Highlights


Normal Result

Abnormality with Condition


Platelet count

150,000-400,000 mm3

Decreased <15,000 mm3

Platelets are used up in the

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