IMAGES IN EMERGENCY MEDICINE Dincer Aktuerk, MD; Mathias Lutz, MD; Heyman Luckraz, MD 0196-0644/$-see front matter Copyright © 2014 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2013.07.508
Figure 2. Ultrasonograph of the patient’s pacemaker pocket, revealing a fluid collection (arrow) anterior to the pacemaker (asterisk).
Figure 1. Swelling on the patient’s right anterior chest wall near his pacemaker pocket site.
[Ann Emerg Med. 2014;63:391.] A 93-year-old man presented with a soft, nontender swelling on his right anterior chest wall near his pacemaker pocket site (Figure 1). He denied other symptoms and was systemically well and afebrile. The patient had multiple comorbidities, including chronic renal impairment, ischemic heart disease, paroxysmal atrial fibrillation, vascular dementia, hypertension, previous subclavian venous thromboses, and polymyalgia rheumatica, for which he was receiving long-term steroids. Ultrasonography of the swelling confirmed a fluid-filled collection at the site of his pacemaker pocket, without a vascular communication between the pocket and subclavian vein (Figure 2). Inflammatory marker (C-reactive protein, leukocytes) and blood culture results were negative. Two hundred millilitres of purulence was drained from the pocket.
For the diagnosis and teaching points, see page 403. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com Volume 63, no. 4 : April 2014
Annals of Emergency Medicine 391
Halpern
Donation After Circulatory Determination of Death
REFERENCES 1. Bernat JL, Bleck TP, Blosser SA, et al. Circulatory death determination in uncontrolled organ donors: a panel viewpoint. Ann Emerg Med. 2014;63:384-390. 2. Wall SP, Munjal KG, Dubler NN, et al. Uncontrolled organ donation after circulatory determination of death—progress, future, and emergency medicine implications. Ann Emerg Med. 2014;63: 392-400. 3. Halpern SD, Truog RD. Organ donors after circulatory determination of death: not necessarily dead, and it does not necessarily matter. Crit Care Med. 2010;38:1011-1012. 4. Miller FG, Truog RD. Rethinking the ethics of vital organ donations. Hastings Cent Rep. 2008;38:38-46. 5. Fost N. Reconsidering the dead donor rule: is it important that organ donors be dead? Kennedy Inst Ethics J. 2004;14:249-260. 6. Miller FG, Truog RD, Brock DW. The dead donor rule: can it withstand critical scrutiny? J Med Philos. 2010;35:299-312. 7. Youngner SJ, Arnold RM, DeVita MA. When is “dead”? Hastings Cent Rep. 1999;29:14-21. 8. Charo AR. Dusk, dawn, and defining death. In: Youngner SJ, Arnold RM, Schapiro R, eds. The Definition of Death: Contemporary
Volume 63, no. 4 : April 2014
9.
10.
11.
12.
13.
Controversies. Baltimore, MD: Johns Hopkins University Press; 1999:277-292. Siminoff LA, Burant C, Youngner SJ. Death and organ procurement: public beliefs and attitudes. Kennedy Inst Ethics J. 2004;14: 217-234. Hornby K, Hornby L, Shemie SD. A systematic review of autoresuscitation after cardiac arrest. Crit Care Med. 2010;38: 1246-1253. Institute of Medicine Committee on Increasing Rates of Organ Donation. Organ Donation: Opportunities for Action. Washington, DC: National Academy Press; 2006. Halpern SD, Barnes B, Hasz RD, et al. Estimated supply of organ donors after circulatory determination of death: a population-based cohort study. JAMA. 2010;304:2592-2594. Gries CJ, White DB, Truog R, et al. An official American Thoracic Society/International Society for Heart and Lung Transplantation/ Society of Critical Care Medicine/Association of Organ and Procurement Organizations/United Network of Organ Sharing Statement: ethical and policy considerations in organ donation after circulatory determination of death. Am J Respir Crit Care Med. 2013;188:103-109.
Annals of Emergency Medicine 403
Figure 2. Ultrasonograph of the patient’s pacemaker pocket, revealing a fluid collection (arrow) anterior to the pacemaker (asterisk).
Figure 1. Swelling on the patient’s right anterior chest wall near his pacemaker pocket site.
[Ann Emerg Med. 2014;63:391.] A 93-year-old man presented with a soft, nontender swelling on his right anterior chest wall near his pacemaker pocket site (Figure 1). He denied other symptoms and was systemically well and afebrile. The patient had multiple comorbidities, including chronic renal impairment, ischemic heart disease, paroxysmal atrial fibrillation, vascular dementia, hypertension, previous subclavian venous thromboses, and polymyalgia rheumatica, for which he was receiving long-term steroids. Ultrasonography of the swelling confirmed a fluid-filled collection at the site of his pacemaker pocket, without a vascular communication between the pocket and subclavian vein (Figure 2). Inflammatory marker (C-reactive protein, leukocytes) and blood culture results were negative. Two hundred millilitres of purulence was drained from the pocket.
For the diagnosis and teaching points, see page 403. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com Volume 63, no. 4 : April 2014
Annals of Emergency Medicine 391
Halpern
Donation After Circulatory Determination of Death
REFERENCES 1. Bernat JL, Bleck TP, Blosser SA, et al. Circulatory death determination in uncontrolled organ donors: a panel viewpoint. Ann Emerg Med. 2014;63:384-390. 2. Wall SP, Munjal KG, Dubler NN, et al. Uncontrolled organ donation after circulatory determination of death—progress, future, and emergency medicine implications. Ann Emerg Med. 2014;63: 392-400. 3. Halpern SD, Truog RD. Organ donors after circulatory determination of death: not necessarily dead, and it does not necessarily matter. Crit Care Med. 2010;38:1011-1012. 4. Miller FG, Truog RD. Rethinking the ethics of vital organ donations. Hastings Cent Rep. 2008;38:38-46. 5. Fost N. Reconsidering the dead donor rule: is it important that organ donors be dead? Kennedy Inst Ethics J. 2004;14:249-260. 6. Miller FG, Truog RD, Brock DW. The dead donor rule: can it withstand critical scrutiny? J Med Philos. 2010;35:299-312. 7. Youngner SJ, Arnold RM, DeVita MA. When is “dead”? Hastings Cent Rep. 1999;29:14-21. 8. Charo AR. Dusk, dawn, and defining death. In: Youngner SJ, Arnold RM, Schapiro R, eds. The Definition of Death: Contemporary
Volume 63, no. 4 : April 2014
9.
10.
11.
12.
13.
Controversies. Baltimore, MD: Johns Hopkins University Press; 1999:277-292. Siminoff LA, Burant C, Youngner SJ. Death and organ procurement: public beliefs and attitudes. Kennedy Inst Ethics J. 2004;14: 217-234. Hornby K, Hornby L, Shemie SD. A systematic review of autoresuscitation after cardiac arrest. Crit Care Med. 2010;38: 1246-1253. Institute of Medicine Committee on Increasing Rates of Organ Donation. Organ Donation: Opportunities for Action. Washington, DC: National Academy Press; 2006. Halpern SD, Barnes B, Hasz RD, et al. Estimated supply of organ donors after circulatory determination of death: a population-based cohort study. JAMA. 2010;304:2592-2594. Gries CJ, White DB, Truog R, et al. An official American Thoracic Society/International Society for Heart and Lung Transplantation/ Society of Critical Care Medicine/Association of Organ and Procurement Organizations/United Network of Organ Sharing Statement: ethical and policy considerations in organ donation after circulatory determination of death. Am J Respir Crit Care Med. 2013;188:103-109.
Annals of Emergency Medicine 403
