Sticky, yes its kind of scary. I've been asked for the dosages of (of all things) amoxycillin and metoclopramide by "a really green Bengali doctor". These are drugs you use everyday and is known to a Filipino 2nd yr med student. Sometimes I see some of them asking for the prescription I gave to discharged patients and perusing it. They give antihistamines for asthma. A Syrian Internist asked me what a 'right lateral decubitus view' is when he heard me order it. And was impressed when I explained what its for. This is something a Filipino med student learns in 3rd year. A Pakistani pediatrician once asked me for the dosage of meperidine HCl (Pethidine, Demerol) in children. A Bengali Pulmonologist (a chest physician) was asking me for help to interpret an ECG tracing, something one learns in med school, polished during internship and 3 yrs internal medicine residency then another 2 yrs as fellow to become a full-fledged pulmonologist. An Egyptian was prescribing a cephalosporin in lieue of ampicillin to a patient we just treated for anaphylaxis due to the ampicillin and I had to explain that the two are like cousins being both beta-lactam antibiotics and the cephalosporin is likely to cause an anaphylactic reaction too. It was made doubly difficult because he is my senior having been here for 7 years. Many times I hear some doctors convince very sick patients that they can be treated at home and I cannot do anything since after doing the initial ER management and stabilizing the patient I have to refer to the speciaIty residents for final disposition. But for several times I have to voice out my objections, the latest was when an Azerbaijan Internist was sending home a still very dyspneic case of congestive heart failure. I am just an ordinary physician in my country and a bit out-dated too - for my several years in the mountains and not finishing any of the trainings I started (internal med, then family med, public health, emergency medicine) - but find myself in this situation where I advise specialists. It is the same story with a Filipino ophthalmologist (eye doctor) I met in Riyadh who told me he was considered a "walking medical encyclopedia" in their hospital and consulted not only on his specialty. There are some good ones though. Windsister, the story made me laugh but it is just a story. You do not put a cast around the chest because the person's lungs can no longer expand, hence he cannot breath. Usually a figure-of-8 adhesive bandaging is used for rib fractures, if the vertebral collumn is compromised the person is immobilized in bed and log rolled every two hours to prevent decubitus ulcers.