It is difficult to say exactly how many of the 163 patients at JHS suffered a PFE without autopsy reports. However, only one case—a patient who decompensated during her procedure and suffered a stroke but ultimately survived to hospital discharge—was presumed to be attributable to PFE.

Instead, the overwhelming majority of post-AFT patients at JHS presented secondary to bleeding, pain, and syncope. Emergency physicians are very familiar with the workup and treatment of these conditions , however EPs must not underestimate the severity of these concerns in a purportedly “minimally invasive” procedure. For example, in our system, 37 percent of patients presenting after gluteal AFT procedures required transfusion, an average of 1.7 units per patient. Nearly half of all post-AFT patients presenting to our emergency departments required admission and six percent required ICU admission. Other complications seen in our cohort included sepsis, hemorrhagic shock, electrolyte derangements, bowel perforation, hematomas, abscess formation, and cardiac arrest.

Communities like South Florida are scrambling to regulate gluteal AFT procedures, but in the meantime, the care of patients like Ms. Baptiste, Ms. Larson, and Ms. Powell will continue to fall to emergency physicians. Pain and bleeding need to be taken seriously in these patients, and for those who present in critical condition, fat embolism must be considered. Familiarity with post-op restrictions for gluteal AFT patients will also improve their care in the emergency department. Until these procedures are regulated in a way that makes them safe for patients, emergency physicians must be ready and equipped to care for them

Dr. Lee is a PGY2 emergency medicine resident at Jackson Memorial Hospital with an interest in critical care disparities and public policy.

Dr. Pyle is an attending physician and ultrasound director at Jackson Memorial Hospital with an interest in medical education, ultrasound and critical care.

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