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Orlando, Florida, United States

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a type of hypoxic respiratory failure that results from ventilation and perfusion mismatching. Inhaled epoprostenol induces relaxation of smooth muscle in pulmonary vasculature, leading to improved oxygenation. OBJECTIVE: To determine if the use of inhaled epoprostenol produced a 10% or greater increase in the ratio of arterial partial pressure of oxygen (PaO2) to fraction of inspired oxygen (FiO2) in ARDS patients and to review adverse events and medication errors. METHODS: An observational chart review was performed based on a report generated from the electronic medical record system. Patients who received at least 1 dose of inhaled epoprostenol from January 1, 2008, to December 31, 2010, at any hospital within the Florida Hospital Health System were considered for inclusion. Demographics, dose, duration of therapy, adverse effects, medication errors, and outcomes data were collected. RESULTS: Sixteen patients were included in the study. Oxygenation improved by 10% or more in 62.5% (10/16) of the patients, with an initial (within the first 4 hours) median increase of 44.5% in PaO2/FiO2. The mean (SD) starting dose was 30 (10) ng/kg/min. Medication errors were observed in 25% (4/16) of patients. Hypotension was the most frequently observed adverse event, with a rate of 18.8% (3/16). CONCLUSIONS: Based on study findings, inhaled epoprostenol may improve oxygenation in patients with ARDS, with findings suggesting a 62.5% response to therapy. The significance of these effects on improving survival remains unknown. The frequency of medication errors observed in this study poses a significant concern regarding the administration of epoprostenol. Further controlled prospective studies are needed to determine the role of inhaled epoprostenol in improving survival in patients with ARDS. © 1967-2013 Harvey Whitney Books Co. All rights reserved. Source

Tirado A.,Florida Hospital East Orlando | Wu T.,University of Arizona | Noble V.E.,Massachusetts General Hospital | Huang C.,Massachusetts General Hospital | And 4 more authors.
Emergency Medicine Clinics of North America

Bedside ultrasound is an extremely valuable and rapidly accessible diagnostic and therapeutic modality in potentially life- and limb-threatening situations in the emergency department. In this report, the authors discuss the role of ultrasound in quick assessment of pathologic conditions and its use to aid in diagnostic and therapeutic interventions. © 2013 Elsevier Inc. Source

Seals R.A.,Florida Hospital East Orlando | Crow T.,Florida Hospital East Orlando
AAO Journal

Neuropathy of the inferior alveolar nerve is not an uncommon complication after dental procedures. In this case, a 36-year-old male had a six-week history of burning pain of the left jaw following a crown lengthening procedure and crown placement. Osteopathic philosophy dictates that the function of the nerve is greatly influenced by the surrounding structures. By diagnosing and treating somatic dysfunctions related to the patient's complaint, the symptoms of the neuropathic pain resolved. This case greatly illustrates the efficacy of osteopathic manipulation and the depth of the anatomy that can be influenced. Source

Reeves C.L.,Florida Hospital East Orlando | Peaden A.J.,Florida Hospital East Orlando | Shane A.M.,Florida Hospital East Orlando
Clinics in Podiatric Medicine and Surgery

Rheumatoid arthritis (RA) is a chronic, degenerative, systemic disease that leads to the destruction of articular cartilage of the joints. Complications, including infection, delays in wound healing, malunion, nonunion, implant failure, and degeneration of adjacent joints soon after primary fusion, have been described in the literature and are generally accepted as commonplace in reconstructive surgeries of the foot and ankle. The combined efforts of the surgeon and supporting physicians to maintain optimal health for the patient, along with the principles discussed in this article, can lead to superior outcomes with fewer complications in the postoperative course. © 2010. Source

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