Gurd criteria for fat embolism
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Major signs
☐Hypoxia (PaO2 <60 mmHg with FiO2 <=0.4)
☐Petechiae (Vest distribution)
☐CNS depression (disproportionate to hypoxemia)
☐Pulmonary edema
Minor signs
☐Tachycardia (HR>110/minute)
☐Pyrexia (Temp>38.5° C)
☐Fat globules in the urine
☐Fat globules in the sputum
☐Retinal emboli
☐Unexplained drop in Hematocrit or platelet count
☐Increasing ESR
R e s u l t s
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Gurd & Wilson's criteria for fat emboli
 
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Gurd criteria for fat embolism

Fat emboli can occur particularly with orthopedic surgery or trauma to long-bones. When fat is released into the venous system, adult respiratory distress (ARDs), shock, stroke, and multiple organ failure are serious risks.

Fat Embolism Syndrome may occur in patients with:

  • Major trauma to long bones
  • Orthopedic surgery to long bones (especially placement of hip prosthesis)
  • Liposuction
  • Osteomyelitis
  • Cancers
  • Serious infections
  • Blood transfusion
  • Burns
  • CABG
  • Collagen vascular diseases
  • Diabetes mellitus
  • Hemoglobinopathies
  • Renal transplant

Gurd & Wilson's criteria for fat embolism syndrome requires the following:

  • Major signs: At least 1 present PLUS
  • Minor signs: At least 4 present

Major signs

  • Hypoxia (PaO 2 <60 mmHg with FiO2 <=0.4)
  • Petechiae (Vest distribution)
  • CNS depression (disproportionate to hypoxemia)
  • Pulmonary edema

Minor signs

  • Tachycardia (HR >110/minute)
  • Pyrexia (Temp >38.5°C)
  • Fat globules in the urine
  • Fat globules in the sputum
  • Retinal emboli
  • Unexplained drop in Hematocrit or platelet count
  • Increasing ESR

References:

  • Bulger EM, Smith DG, Maier RV, Jurkovich GJ. Fat embolism syndrome. A 10-year review. Arch Surg. 1997;132(4):435-9.
  • Glazer JL, Onion DK. Fat embolism syndrome in a surgical patient. J Am Board Fam Pract. 2001;14(4):310-3.
  • Gurd AR. Fat embolism: an aid to diagnosis. J Bone Joint Surg Br. 1970;52(4):732-7.
  • Gurd AR, Wilson RI. The fat embolism syndrome. J Bone Joint Surg Br. 1974;56B(3):408-16.
  • Huber-lang M, Brinkmann A, Straeter J, et al. An unusual case of early fulminant post-traumatic fat embolism syndrome. Anaesthesia. 2005;60(11):1141-3.
  • Schult M, Frerichmann U, Schiedel F, et al. Pathophysiology of Fat Embolism after Intramedullary Reaming. European Journal of Trauma. 2003;29(2):68-73.