A 40-year-old man, was admitted with FRACTURE shaft femur following a road traffic accident. On 2nd day he became disoriented. He was found to be tachypnoeic, and had conjunctival petechiae. Most likely diagnosis is

(C) Fat embolism # Fat embolism & ARDS:* Fracture through a large marrowfilled cavity almost inevitably results in small showers of fat emboli being swept to the lungs.* This can usually be accommodated without serious consequences, but in some cases (and especially in those with multiple injuries & severe shock, or in patients with associated chest injuries) it results in progressive respiratory distress and multi-organ failure.* Blood gases should be measured soon after admission, and any suspicious signs such as shortness of breath, restlessness or a rise in temperature or pulse rate should prompt a search for petechial haemorrhages over the upper body, axillae and conjunct vae.* Treatment is supportive, with the emphasis on preventing hypoxia and maintaining blood volume.