Correct!
4. 1 and 3

Treatment for fat embolism syndrome is primarily supportive. Several studies have assessed adjunctive pharmacologic therapies for FES, including heparin, aspirin, statins, and anti-inflammatory agents, with overall inconclusive results and a lack of high quality evidence (5). The most commonly studied agent has been corticosteroids. A 2009 meta-analysis of 7 studies (n=389) by Bederman et al. (9) found that administration of corticosteroids to patients with long bone fractures reduced the risk of FES by 78%, with a number needed to treat (NNT) of 8. Notably, the authors of this article found the quality of the trials to be poor, and found no differences in mortality with steroid use (9). A similar meta-analysis by Sen et al. (10) from 2011 identified 7 randomized trials (n=483) that evaluated corticosteroids in patients with lower limb fractures. They found a decreased risk of FES with steroid use; 9/223 patients in the steroid-receiving group compared with 60/260 patients in the control group developed FES, respectively (p<0.05). Again, the authors expressed concerns about the lack of uniformities in the studies, making it difficult to draw definitive conclusions about steroid use.

What is the underlying mechanism of fat emboli syndrome? (Click on the correct answer to be directed to the sixth and final page)

1. Mechanical obstruction resulting from release of fat thrombi into the pulmonary and systemic vasculature
2. Release of micro-fat emboli into the venous system, resulting in disseminated intravascular coagulation (DIC)
3. Systemic inflammatory response to high concentrations of free fatty acids in the vasculature
4. 1 and 3
5. All of the above

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