Feeling of Imminent Death after Long Bone Surgery


Feeling of Imminent Death after Long Bone Surgery


Guzmán Rodríguez, Raúl; Borregón Rivilla, Miguel; Palomares Morales, Aitana

Doctors of the Virgen de la Salud hospital at Toledo (Spain).


71-year-old male patient with hypertension, obesity and personal history of prostate adenocarcinoma with blast bone metastases.

Admitted after fall and pathological right pertrochanteric fracture. Programmed surgery is performed by means of endomedullary nailing on the fractured right hip and prophylactic left hip. Pre-surgical nasopharyngeal exudate for coronavirus is positive, with no apparent clinical translation.

Three hours after surgery, the patient begins with dyspnea, central thoracic pain of a pleuritic nature and a feeling of imminent death. Physical examination reveals poor general condition, hypotension, diaphoresis, tachypnea and desaturation, without neurological affectation. Treatment is initiated with intensive serotherapy, oxygen therapy and analgesia.

Analysis reveals troponin and normal NT-proBNP with elevated LDH and D-dimer, as well as mild metabolic acidosis. The electrocardiogram and transthoracic echocardiogram do not show any alterations. Urgent pulmonary CT-angiography targets signs compatible with fat embolism (see figure 1).

The hemodynamic and respiratory instability improve progressively, not requiring admission to ICU, appearing at twelve hours bilateral axillary petechiae.

Pulmonary fat embolism syndrome is rare, and can appear after fractures and long-bone surgery [1]. The classic clinical triad is hypoxemia, neurological alteration and petechiae[²], due to the presence of fatty emboli in the circulation and pulmonary parenchyma.


Keywords: Dyspnea; Fat embolism; Petechiae


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How to cite this article:

Guzmán Rodríguez, Raúl; Borregón Rivilla, Miguel; Palomares Morales, Aitana. FEELING OF IMMINENT DEATH AFTER LONG BONE SURGERY. International Journal of Case Reports, 2020; 4:185. DOI: 10.28933/ijcr-2020-11-2305


References:

1. Yeo S, Chang H, Sohn S, Cho C, Baec K. Pulmonary and cerebral fat embolism syndrome after total knee replacement. J Clin Med Res. 2013;5:239-42.
2. Figueroa D, Figueroa F, Calvo R, Figueroa M. Cerebral and pulmonary fat embolism after unilateral total knee arthroplasty. Arthroplast. Today 2019;5:431-34.