Biomedical subjects
Publications and source records attributed to S S Tachakra.
A patient who sustained exceptionally severe damage to the main blood vessels and to the collateral circulation of his left lower limb is reported. The femoropopliteal vein was replaced by a Dacron prosthesis which remained patent for 6 weeks until an adequate collateral circulation was established.
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When patients in whom a fat embolism rash developed were nursed on their left side fresh petechiae appeared on the right side and vice versa. The appearance of petechiae on the least dependent site is consistent with the skimming off of floating fat emboli in the blood and their selective distribution by the branches arising from the top of the aortic arch.
Second episodes of clinical fat embolism have not previously been reported. This paper presents the case report of a patient with multiple fractures who developed two distinct attacks with a symptom-free interval. The second attack was partly responsible for death, and histological examination confirmed the diagnosis.
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Serial arterial blood-gas analyses showed a phase of primary hypoxaemia in thirty-two out of fifty fracture patients (64 per cent) without head, chest or abdominal injury. The incidence was greater in those with shaft fractures of the femur or tibia or both, than in those with fractured hips, and was related to the severity of injury and the nature of the accident. Most affected subjects were already hypoxaemic on admission to hospital; the arterial PO2 commonly fell to between 60 and 70 millimetres of mercury, and the episode generally lasted a few days. The hypoxaemia was generally subclinical but four patients developed mild fat embolism. Early hypoxaemia was not found in six patients admitted with only soft-tissue injuries. One or more subsequent attacks of subclinical hypoxaemica, each lasting a few days, occurred in half of those previously affected. Most episodes followed fracture operation or manipulation. Pulmonary thromboembolism seemed responsible in two patients, but it could be excluded in others given oral anticoagulant prophylaxis from soon after admission. Pulmonary fat embolism is the most likely explanation of the primary episodes and could account for most of the subsequent periods of hypoxaemia.