[Dyspnea or confusion after trauma? Consider fat embolism syndrome].

Three patients, 2 women aged 26 and 19 years and a 65-year-old man, underwent surgical fracture treatment after a motor vehicle accident with fractures of the lower extremity. They developed respiratory distress from fat embolism syndrome. After maximal support in the ICU 2 of them died and 1 recovered. Fat embolism syndrome is a clinical condition mostly seen after long bone fractures. The main features are respiratory distress, cerebral confusion and a petechial rash. Usually the presentation is quite benign, but severe morbidity and even mortality can occur in some cases. It is caused by a combination of a mechanical and a biochemical pathway. Therapeutic options consist of respiratory and haemodynamic support. Preventive measures are rapid fracture fixating, good analgesia, adequate fluid infusion and tissue oxygenation.