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Air embolism is a rare but potentially fatal complication of pleural drainage. We present a case of a late elderly man who developed a cerebral air embolism shortly after the removal of a chest drain inserted for empyema, in a setting without positive pressure ventilation. This resulted in a catastrophic neurological deterioration and death. The case highlights the importance of recognising air embolism as a differential in post-drain removal collapse, understanding its proposed mechanisms, and considering preventative measures. This report contributes to the limited literature on air embolism following chest drain removal and underscores the need for vigilance during all stages of pleural drainage management.
BACKGROUND:Fascia iliaca blocks (FIB) are recommended by national guidelines for analgesia in neck of femur (NOF) fractures to reduce opioid burden. However, evidence supporting universal administration is largely derived from patients with moderate-to-severe pain. It remains unclear whether ``blanket'' FIB protocols benefit the heterogeneous population presenting to emergency departments. OBJECTIVES:To evaluate real-world analgesic efficacy of FIBs across baseline pain severities and to assess whether a targeted approach is justified. METHODS:Single-centre, retrospective case-control study of adults presenting to a UK Major Trauma Centre with radiologically confirmed NOF fractures. Changes in pain scores and opioid consumption (Morphine Milligram Equivalents [MME]) were analyzed pre- and post-intervention. Outcomes were compared between FIB and standard analgesia, and between ultrasound-guided and landmark techniques. RESULTS:Of 112 included patients (80.2 ± 9.4 years; 74.1% female), 87 (77.7%) received a FIB. While FIB resulted in a statistically significant reduction in pain scores (4.7 ± 3.8 to 2.0 ± 2.8; p = 0.003), it did not significantly alter opioid consumption (median 0.00 vs 0.47 MME/h; p = 0.961). Subgroup analysis revealed that analgesic benefit was strongly correlated with baseline pain (r = 0.771, p < 0.001); patients with rest pain <4 derived minimal benefit. No significant difference in efficacy was observed between ultrasound-guided and landmark techniques. CONCLUSION:Universal FIBs for NOF fractures may represent an inefficient use of resources for patients with low baseline pain. A stratified protocol prioritising patients with moderate-to-severe pain (Visual Analogue Scale [VAS]/Numerical Rating Scale [NSR] ≥ 4) is recommended.
Background Renal denervation (RDN) has emerged as a guideline-recommended therapeutic option in hypertension management with several high-quality, randomised, placebo-controlled trials demonstrating efficacy and safety. However, the lack of expert consensus on patient selection for RDN in the UK has led to debate regarding its use. This study aimed to establish a multidisciplinary consensus to provide clinicians and commissioners with guidance on the appropriate use of RDN in hypertension management within the UK. Methods The project used a modified Delphi method. A steering group (SG) of seven clinicians in cardiology, clinical pharmacology, radiology, nephrology and general practice, all experienced in managing patients with hypertension, convened in June 2024. The SG aligned on 40 consensus statements covering key topics (patient identification and selection, multidisciplinary team collaboration, commissioning and guidelines, training and education and awareness of RDN). The statements were distributed as an online survey to UK clinicians involved in hypertension management. Respondents assessed their level of agreement using a four-point Likert scale. Consensus was predefined as 75% agreement. The surveys were collated anonymously and independently analysed. The results were shared with the SG in November and December 2024. Results A total of 125 responses were received from interventional cardiologists and radiologists, cardiologists, clinical pharmacologists and nephrologists across various regions of the UK. Consensus was achieved for 37 out of 40 statements (93%). Based on the consensus scores, 11 key recommendations were developed by the SG regarding patient selection, multidisciplinary collaboration, clinician training and commissioning for RDN. Conclusions This expert consensus defines patient selection criteria for RDN and provides 11 recommendations to support its use. RDN should be considered for resistant hypertension or intolerance to medications, using a multidisciplinary approach. Implementation of these recommendations could guide clinical practice, inform commissioning and support National Institute for Health and Care Excellence reviews, ultimately improving patient access across the UK.
