Fun Facts From Rotations

Here are some things I learned on my rotation this week.

We had a gentlemen with a Hb=17.9 The range for men is 13.8 to 17.2
Polycythemia is the condition and in this case, it is smoker's polycythemia. There are multiple forms. Primary is of unknown cause. Secondary, has a known cause. Known causes include, COPD, carbon monoxide exposure (long-term like smoking), tumor of the kidney. In this patient case, the carbon monoxide from smoking attachs to the Hb allowing less oxygen transport to the tissue causing hypoxia at the tissue. This signals the body to increase erythropoietin production from the kidney, causing an increase in RBC production from the bone marrow. In COPD patients, inadequate oxygen exchange at the alveoli causes hypoxia at the tissue resulting in the same upregulation of erythropoietin production. Tumors in the kidney or malfuction in the bone marrow may also lead to polycythemia but have different etiologies.

Adcirca (Tadalafil, aka Cialis) was recently approved for treatment of pulmonary arterial hypertension at 40mg po Daily. Revatio (Sildenafil) is also used for treatment of PAH.

Sodium bicarbonate drips are used as renal protectants for patients undergoing procedures requiring a contrast dye. I knew about acetylcysteine, but not sodium bicarb.

Most importantly: If you drop a stent on the floor during an angioplasty, you lose $3000 and hopefully not your job.