A 22-year-old construction worker falls 30 ft and fractures several bones, including his femoral shafts. Six hours later, the patient develops shortness of breath and cyanosis. Which of the following hemodynamic disorders best explains the pathogenesis of shock in this patient?

Fat emboli originate from adipose tissue in the medulla of fractured long bones. Fat carried by venous blood reaches the lungs, filters through the pulmonary circulation, enters arterial blood, and is disseminated throughout the body. The occlusion of cerebral capillaries is accompanied by petechial hemorrhages in the brain and is the most important complication of fat embolism. Acute myocardial infarction (choice A) would be unlikely in a 22-year-old patient. Deep venous thrombosis (choice B) and septic shock (choice E) would be unlikely within this time frame. Paradoxical embolism (choice D) refers to emboli that arise in the venous circulation and bypass the lungs by traveling through an incompletely closed foramen ovale, subsequently entering the arterial circulation.Diagnosis: Fat embolism