All trauma victims require high-flow supplemental oxygen utilizing a rebreathing bag or intubation. Ventilation should be assisted if appropriate. Serial arterial blood gas analyses and pulse oximetry should be used to identify and prevent hypoxia ( Table,,,?).

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Table 2 Summary of management of fat embolism syndrome

If fat embolism syndrome presents unexpectedly after an interval, or is initially unrecognized, more aggressive measures may be required such as endotracheal intubation and mechanical ventilation, often using high positive end-expiratory pressure (PEEP) to open and recruit collapsed alveoli. Such patients must be managed in an intensive care setting where invasive monitoring is possible.

Mortality appears to be related to the degree and duration of hypovolemic shock. Initial management should involve early recognition and vigorous resuscitation, initially with warm Ringer's lactate followed by blood. Hypothermia is a further aggravating factor which may be exacerbated by the administration of cold resuscitation fluids.

Injured tissues and fractures must be handled gently, avoiding unnecessary manipulations, with early splint application. All lower limb and pelvic fractures require early reduction and immobilization, with external or internal fixation where appropriate. This particularly applies to pelvic and femoral shaft fractures.

Controversial measures for treating fat embolism syndrome include the use of corticosteriods. Although improvement in clinical outcome has not been consistently shown, studies indicate that their early use may reduce the overall incidence of fat embolism syndrome in particular subsets of patients ( Lindeque ei a/ 1987).

However, their routine use cannot be recommended at present. There have been trials of many other agents, including aspirin, dextran, and alcohol, but to no avail.

In summary, management is largely supportive if not preventive. Supplemental oxygen must be delivered to maintain a PO2 of greater than 8 kPa (60 mmHg). There should be early recourse to intubation and ventilation using PEEP if adequate oxygenation is not achievable by simpler measures. The key is early consideration and intervention.

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