Last week, I took care of a 25 year old male, Mr. L, who had a motorcycle accident. He had bilateral femur fractures, a pelvis fracture, and a right tib-fib fracture. He was drinking during the accident and had a small subdural hematoma from not wearing a helmet. Upon receiving him from the Operating Room, he was intubated, sedated, and on pain medications. The orthopedic team had done an ex-fixation on his right lower extremity, plated his pelvis, and proceeded with a right ORIF of his femur fracture but not his left at this time. I was weaning off the sedation to get a full neurological assessment when he became tachycardic and tachypnic. When asked to follow commands, he would squeeze my hands but not wiggle his toes. He would open his eyes but not track when spoken to. He was becoming frantic and looked to be air hungry. At that point his oxygenation started to decline. I went from a Spo2 saturation of 98% down to 78%. I called the respiratory therapist to come assist and help bag the patient. We turned up his Fi02 to 100% and started bagging. I called the trauma service managing my patient and updated them on his condition. I sent off an ABG to assess his oxygenation and a full set of labs. I re-sedated him and received an order for a bolus of pain medicine. I got him back to a resting rate and a lower tachycardia but his oxygenation was not improving. My first thought was a pulmonary embolism or fat embolism secondary to his long bone fractures. I mentioned this to the physician and they immediately ordered a stat CT Angio of the chest. An hour later, I was back in my room post scan with the radiologist calling with the result. There was a cluster of fat emboli throughout the left lung causing him to not oxygenate. I also mentioned to the physician that when I pulled the sample of blood I sent to the lab, there was large fat molecules that I wasted and sent in the tubes. The patient does not have a history of high cholesterol that would normally cause this to happen. I wasted some blood again to show them and brought to their attention that the last time I saw this happen, the patient also had the fat emboli travel to their brain causing severe brain damage that ultimately led to that patient's death. Upon hearing this, the physician felt it was in due cause to order a stat head CT to check on the brain. My suspicions were right. I received a call from the radiologist stating he could see several new areas of infarct from what probably is caused from fat emboli showering into his brain. I called the physician immediately and informed them of this change in status. There really isn't much you can do for fat emboli like you can for blood clots. There is no medicine to give to help dissolve them or remove them. At this time the only thing we can do his just help support him and maintain ample oxygenation. WhenI tried to reassess his neurological status again in the shift, my patient was not following any commands and his pupils were equal but sluggish. The physician had made several vent changes to help increase his saturation with no success. They called the attending on call and received an order for Nimbex to paralyze the patient so their respiratory drive was subdued. Not letting him work to breathe might allow his lungs to do a better job with the occlusions they had. I started the Train of Four (TOF) with a baseline of 4/4 twitches on 4 amps. I started the Nimbex per policy and titrated it up to a TOF of2/4 twitches. With the patient paralyzed, I was able to increase his saturation from 78% to 92%. I received an order for Flolan and the respiratory therapist connected and started this medication to help make the blood carry the oxygen easier throughout the body. I placed the "No pregnant caregiver" sign on the door and informed the staff of the new medication added. I then talked to the doctor about this young patient's prognosis. I asked them what else we could possibly do for him and all they said was "just wait". I had the physician call the patient's mother and update her on her son's condition. I felt that she should be here in case he doesn't pull through this. An hour later, his mother and father were at the bedside crying over their son. Then the arguing started. The patient's parents were not on the same page about their son's quality of life. The dad made it clear that if the physicians felt he was not going to improve, that he wanted his son to be made a DNR and all this "nonsense" betaken off and for him to pass peacefully. The patient's mother on the other hand, wanted everything done for her son no matter the result or consequence. I immediately called the chaplain to come to the bedside to help talk to the parents. I felt with their experience they could help them both make intelligent decisions and maybe come to a middle ground. I asked my charge nurse to come over and see if they could talk with them while I took care of their son. I still had so much to do. The ethical dilemma surrounding my patient is one I see a lot when it comes to families not agreeing on hard life choices. By the time my shift was over, the parents had agreed to give their son a certain amount of time before making any rash decisions. They would wait and see if the clots would migrate or move on and his condition improve or possibly decline. At shift change, I had his saturation at barely 90% adequately paralyzed and sedated per policy. He was on pain medications as well, and did not look like he was struggling like he was before. I feel like I made some really good decisions concerning my patient's care and acted appropriately to get the best results that I could. It has been a week since I took care of Mr. L, and when I came to see how he was doing I was informed that he didn't make it. He was so young to be taken so soon. The family came together in the end and agreed on letting him go when he stopped making any neurological progress,and his condition was declining despite the medical team's hard work.