An Introduction to “Advanced Life Support” in Adults
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Primary Survey and Initial Imaging
Secondary Survey and Further Imaging
Main Findings on Secondary Assessment:
Assessment of the face, head, neck, abdomen, pelvis and chest was unremarkable
Mobile x-ray shows a mid shaft femur fracture:
CT Scanning – Uncomplicated T11 fracture, No solid organ injuries
The next day the patient had her femur fixed and post operatively was making an uneventful recovery. However, on day 2 our patient was noted to be increasingly confused with reduced O2 saturations.
The patient’s GCS dropped to 12 and she became agitated.
The O2 sats were 88% on RA.
An urgent CT head and chest was normal.
The patient became anaemic with a HB of 70 with Platelets of 80.
A petechial rash was noted.
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A Provisional diagnosis of Fat Embolism Syndrome was made…
Fat embolism syndrome (FES) typically manifests 24 to 72 hours after the initial injuries. However, FES may rarely occur as early as 12 hours or as late as two weeks after a traumatic injury.
Affected patients develop a classic triad (none of which are specific for FES diagnosis):
Neurologic abnormalities are common. They typically present after respiratory symptoms. Neurologic manifestations include acute confusional state, altered level of consciousness, seizures as well as specific focal neurological deficits.
One study reported that mental status changes occurred in 59 percent of patients.
A number of other less common manifestations of FES may also be present:
These include anaemia, thrombocytopenia, visual loss (Purtscher’s retinopathy), lipiduria, fever (non-specific), coagulopathy, disseminated intravascular coagulation (DIC) and cardiac complications (e.g. right ventricular dysfunction and hypotension)
An Important Statement from The ACEM President
Following on from previous communication to you, the ACEM Board has recently expanded the membership of the Expert Advisory Group (EAG) on Discrimination. The revised Terms of Reference for the EAG are available on the ACEM website.
I am pleased to confirm the membership of the EAG as follows:
- Dr Helen Szoke — Chair, External Appointee
- Professor Ron Paterson — Deputy Chair, External Appointee
- Professor Kichu Nair — External Appointee
- Dr Simon Judkins — President-Elect
- Dr Yusuf Nagree — Chair of the Council of Advocacy, Practice and Partnerships
- Dr Hussain Kadim — Specialist (FACEM) Training Program trainee
- Dr Danika Thiemt — Specialist (FACEM) Training Program trainee
- Dr Mahesh Gangadharaiah — Recently qualified FACEM
The EAG is now calling for written submissions from ACEM trainees, Fellows and SIMGs in order to seek information relevant to its core tasks.
The Call for Submissions is available on the ACEM website and provides important information on this process. Those wishing to make a submission have until 5.00pm (AEST) on Wednesday, 12 April 2017 in order to do so.