Fat embolism as a cause of respiratory insufficience

The case report describes a fat pulmonary embolism during a cemented hip arthroplasty procedure. A 70-yr-old woman required a cemented hemiarthroplasty for hip fracture. Her medical history consisted of non-Q myocardial infarction two years ago. Current medications were ACE inchibitor and nitrates. Low molecular weight heparin was given night before surgery. During the cementing of the canal and insertion of the femoral prothesis a ventricular arrythmia occured, blood pressure declined to 80/60 and patient´s oxyhemoglobin saturation decrease to 92%. The patient underwent a successful intraoperative resuscitation and was transferred to the intensive care unit. In the postoperative course she developed an acute coronary syndroma and non-Q infarction of the heart, acute renal and respiratory failure. Fourth day after surgery she suffered fatal cardiac arrest . The autopsy findings revealed multiple fat vacuoles in the pulmonary vasculatures and confirmed the cause of death as fat embolisation.