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Washington University Experience | MYELIN (NON-IMMUNE MEDIATED) | Fat Embolism | 12A0 Case 12 History
Case 12 History ---- The patient was a 52 year old obese man with a long history of hypertension who experienced a syncopal attack at work that led to a fall down half a flight of stairs. On arrival, EMS noted he was awake, hypertensive and an EKG showed bi-fascicular block, inferior lateral ST-elevation in aVR as well as diffuse ST depression, concerning for left main coronary artery disease. On arrival at the ED, the patient had a PEA arrest. He was cannulated with VA ECMO following 40 minutes of CPR. In the cardiac catheterization laboratory, severe disease in the proximal to mid RCA and downstream circumflex bifurcation were found in addition to a moderate to severe disease in the in the mid LAD. He underwent bifurcation stenting of the left main and ostial circumflex. In the CCU he was mechanically ventilated with VA ECMO. During his hospital course he developed cardiogenic shock with ischemic changes in the bowel, liver and left arm, and died 2 days after onset of his MI. At no time did imaging studies show long bone or pelvic fractures. His care had been complicated by shock liver with steatosis, acute kidney injury, acute respiratory failure, ischemic ileus and left upper limb ischemia. At autopsy additional findings included significant soft tissue trauma, pancreatitis, and ischemic hepatitis. There were multiple rib fractures resulting from CPR. Thus, in this patient there were numerous issues contributing to risk for fat emboli to the brain.
