Correct!
3. Recruitment maneuvers to lower FiO2
Fat embolism is possible from a humeral fracture although more commonly seen from the long bones of the leg. However, The use of corticosteroids in fat embolism is controversial (3). She meets the criteria for the adult respiratory distress syndrome (ARDS). The probable cause is pulmonary contusion. Her FiO2 does eventually need to be lowered in order to prevent oxygen toxicity. Sometimes lowering the FiO2 results in minimal fall in the pO2, but unfortunately, that was unsuccessful in this case. Recruitment maneuvers to increase the pO2 should be initially tried because of the speed and ease of many of these maneuvers (4). These can include:
Unfortunately, none of these were successful either. For this reason a trial of venous-venous ECMO was begun which raised the pO2 sufficiently to lower the FiO2 to 60% (4). After 9 days ECMO was discontinued.
What is the greatest risk to the patient's survival at this time? (Click on the correct answer to proceed to the sixth and final panel)