Teen with muscular dystrophy and tibial fracture and altered mental status

Patient

Q: I can't find a category that 'matches'. What is your first thought when you read the case below? 14 year old male with muscular dystrophy, non-ambulatory but otherwise healthy and neurologically normal. Presents to ED with fractured tibia, with altered mental status following injury (no head trauma at all; basically unresponsive less than 20 minutes following injury). Brain CT normal. O2 sats variable on nonrebreather. Heartrate in 160s. Spontaneous resps around 24. Chest film shows infiltrates indicative of aspiration. Approx. 3 hours from injury, O2 sats on NRB are low 80s; patient arrests and dies.

Doctor

A:   Depending on the type of Muscular Dystrophy, age of onset and parts of the body the symptoms primarily affect and how rapidly the disease progresses it would be necessary to rule out compromise of the heart muscle.
Another important cause to rule out in this particular case is a possibility of a fat embolism that traveled from the fractured bone traveling to his lungs and possibly the brain.

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