What are the key clinical features to consider when diagnosing fat embolism syndrome in a patient following trauma?

When diagnosing fat embolism syndrome (FES) in a patient following trauma, the key clinical features to consider include a classic triad of respiratory distress, neurological impairment, and petechial rash. Respiratory symptoms typically present as hypoxia, tachypnoea, and dyspnoea, often developing within 24 to 72 hours after the traumatic event, especially long bone fractures or major orthopaedic injuries ¹. Neurological signs can range from confusion and altered mental status to seizures and coma, reflecting cerebral fat embolism and associated brain injury (Morales-Vidal, 2019; Davis et al., 2020). The petechial rash, usually appearing on the upper body, conjunctiva, and oral mucosa, is a distinctive but less common feature that supports the diagnosis ¹. Additional clinical features may include fever, tachycardia, and anaemia. Diagnosis is primarily clinical, supported by the temporal relationship to trauma and exclusion of other causes. Imaging, such as chest X-ray or CT, may show diffuse pulmonary infiltrates but is not diagnostic alone (Newbigin et al., 2016). Early recognition of this constellation of symptoms in the context of recent trauma is critical for prompt management ¹.