# Suspected Fat Embolism Syndrome in the Setting of Ballistic Long Bone Fractures: A Case Report

## TL;DR

A 22-year-old woman with gunshot-related long bone fractures showed signs of fat embolism syndrome and improved with supportive care.

## Contribution

Highlights FES presentation in ballistic fractures and emphasizes timely recognition for effective supportive care.

## Key findings

- Patient with ballistic long bone fractures showed hypoxia consistent with FES despite no thoracic injury.
- Supportive care including oxygen and monitoring led to patient improvement and stable discharge.
- Emergency physicians should recognize non-classic FES symptoms for timely intervention.

## Abstract

Fat embolism syndrome (FES) is a rare, life-threatening condition most seen in traumatic orthopedic injuries, especially long bone fractures. Classically, FES presents with hypoxemia, neurological abnormalities, or a petechial rash; however, clinical findings can extend beyond this classic triad. Since FES is a clinical diagnosis, emergency physicians must recognize both classic and subtle presentations.

A 22-year-old female presented as a transfer from an outside hospital for multiple long bone fractures secondary to gunshot wounds. Upon arrival, she was found to be hypoxic, despite no signs of thoracic injury on exam or initial imaging. Her presentation, laboratory findings, and repeat imaging were consistent with FES. She was given supportive care through supplemental oxygen and close monitoring. She improved with supportive care and was discharged home in stable condition.

Although there is no definitive treatment for fat embolism syndrome, prompt recognition of the various clinical findings associated with FES by emergency physicians can expedite supportive care, allow prompt admission to a critical care unit, and aid with monitoring for potential deterioration.