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The triad of hypoxemia (dyspnea) and confusion (disorientation and depressed consciosness) and Petechiae is classic for pulmonary fat embolism.

In real life (therefore in USMLE questions) the main differential is Adult Respiratory Distress Syndrome ARDS. Because both of them usually presents few days after the setting of a major trauma that may involve bony fractures.

However, classically the development of petichiae specially in the neck or axilla should makes us choose the fat embolism as the answer.

In ARDS you get other clues such as unresponsive to Oxygen and ground glass lung fields in X rays.

It's important to remember that unlike the usual thromboembolic pulmonary embolism we don't anticoagulate patients with fat embolism.
 

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The triad of hypoxemia (dyspnea) and confusion (disorientation and depressed consciosness) and Petechiae is classic for pulmonary fat embolism.

In real life (therefore in USMLE questions) the main differential is Adult Respiratory Distress Syndrome ARDS. Because both of them usually presents few days after the setting of a major trauma that may involve bony fractures.

However, classically the development of petichiae specially in the neck or axilla should makes us choose the fat embolism as the answer.

In ARDS you get other clues such as unresponsive to Oxygen and ground glass lung fields in X rays.

It's important to remember that unlike the usual thromboembolic pulmonary embolism we don't anticoagulate patients with fat embolism.
This same clinical presentation can also be for DIC. However, I guess question stem would likely give clues indicating DIC or fat embolism (ie. DIC- coag studies off; fat embolism- recent trauma).

Thanks for the tip about not reversing fat embolism with anticoag.
 
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