Special embolism types (fat, air, amniotic)

The earlier a broken thigh bone is splinted or fixed, the less fat is pressed out of the marrow. That is the most important lever, and it lies with the ambulance service.

Fat embolism often shows up only with a delay: breathlessness, confusion, fine red dots on shoulders and armpits. Telling the nursing team shortens the road to the diagnosis a lot.

Never hold your breath on the ascent, keep to the ascent rate, do the safety stop. And keep the diving hotline number in the phone — trouble after surfacing belongs discussed there, even if it seems mild.

When a central line is placed or pulled, the person lies flat or slightly head-down and bears down on an out-breath so no air is drawn in. Knowing this makes it possible to ask.

Amniotic fluid embolism is very rare and cannot be foreseen; it cannot be prevented, but it can be treated. That is the one argument that counts here — without turning it into nine months of worry.

In these forms there is no drug that dissolves the blockage — treatment is supportive: oxygen, fluid, circulation. In air embolism, positioning counts: on the left side with the head down, so the air stays in the right atrium. In fat embolism after a fracture, the picture appears one to three days later, and early stabilisation of the bone lowers the risk. Cortisone and heparin changed nothing in studies.

Fat embolism typically shows twenty-four to seventy-two hours after a fracture of the long bones, with breathlessness, confusion and pinpoint skin bleeds — that delay is the identifying mark. An air embolism becomes critical from about fifty millilitres and life-threatening from two to three hundred. Amniotic fluid embolism is rare — about two to eight per hundred thousand births — and almost always occurs during or shortly after the birth.

All of these are medical emergencies.

With a fat embolism the platelets drop, often together with anaemia. This happens one to three days after a break of the large long bones.

Raised, but non-specific. It does not answer which kind of embolism is present — the course and the imaging do that.

Rises with the accompanying inflammatory reaction. Together with breathlessness, confusion and pinpoint bleeding into the skin the typical picture of fat embolism emerges.

They lower the blood fats and act on the excitability of the heart muscle. Oily sea fish twice a week is the best-supported route; very high doses from capsules are not a harmless more.

Keeps the rhythm steady and lowers blood pressure. Water tablets drive it down, certain blood pressure drugs and a weak kidney drive it up — which is why it is checked under treatment.

A lack favours extra beats and at the same time keeps a potassium deficiency going. Anyone replacing only the potassium sees no success while the magnesium is missing.

Less salt lowers blood pressure measurably, and most of it is not in the salt cellar but in bread, cheese, cured meat and ready meals. With very low blood pressure the opposite applies.

Effects on inflammation and triglycerides established; cardiovascular prevention is mixed. Watch quality and freshness.

Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.

Amniotic fluid embolism occurs during birth and shortly afterwards — exactly in the phase when oxytocin drives the contractions. It is very rare and not predictable; that belongs among the things one has to say honestly.

Fat embolism mostly comes one to three days after a fracture of the large long bones. Cortisone has been studied for prevention — with inconsistent results and no binding recommendation.

In recovery protein and energy come first — 1.2 g per kg body weight a day is the usual frame until strength returns.

In the recovery phase mobilisation is stepwise. How fast depends on the cause — after a fat embolism from a fracture it differs from after a procedure.