Any plans for the 4th of July?

This coming weekend is a long street fair, both days, the "Fillmore Jazz Festival." So I think I'll check this out.

Will be on vacation.

City parade (I'm a participant), tea party, and possible family BBQ.

I think we're going to a friend's shindig. I think it's for a friend of the friend, really, who's becoming a US citizen some time around the 4th.

Hah, where in the world is there no 4th of July???

Will likely stay in the house where it's cool. It's been over 100 degrees this week (110 on Sunday). By July 4th it might go down to 95.

Now that all the grandkids are gone there is no reason to barbeque or buy fireworks. It will be just another Saturday.

no plans but i will celebrate Canada Day tomorrow.

Yes, a family party.

I am going to be shattered. Sleep sounds good, but I also need to get some laundry done and do some reading. It would be nice if I could persuade someone to let me practice my examination skills on them too. My American housemates are going to be away.

Other: There is a 4th of July here, but it doesn't mean anything (sorry, I'm being snarky...)

Anyway, my plans for today (July 1st, which is Canada Day) are seeing a movie and then doing some shopping and drinking at my favourite street festival.

I wish there was no 4th of July this year for me... I wish I could just skip that day and land right into Sunday from Friday - it would make life simpler.

working a 24 hr shift.........

I didn't think I had plans for the fourth of July until July 2nd, when my son asked me, "You ready for the fourth of July dad?" I asked, "What's happening then?" "We're going to Town Point Park with Dave and Irene!", he answered. So I asked Sharon about it, she said,"Yes, we talked about this last week, Curt." I said, "Really??? Where the hell was I when we had this conversation?" I had no idea. Oh well, I guess the answer is yes, I do have plans for the fourth, even though I was unaware of the fact...

Yes I have plans.. I will do the same thing I do every day, plot try and take over the world! and sit at home and ignore all the fools out there celebrating.

I was planning to invade, but something came up.

If it's a prostate examination, you'll need some pretty good persuasion skills.

If I was on a gastro-intestinal ward, I would probably have done one by now - which would be good as I think I'm more nervous about doing a rectal examination than I was about taking blood. In fact, even more nervous than having to do an arterial blood gas tomorrow (I've only taken blood once, and now I'm going to be let loose with a needle and someone's artery?)

When I was observing in an ED for my EMT training, I watched a guy draw arterial blood from a patient. I never want that done to me; it looked extremely painful. Not to make you nervous or anything.

That's what I'm worried about. I've seen quite a lot done in the past and I've very rarely seen anyone hit the artery perfectly straight away - there's usually a bit of fishing, which has to be awful for the patient. People are very stoic where I'm training so I think most people will bear it fairly well, but I hate the thought of hurting someone because I'm not experienced enough. I drew my first (venous) blood on Friday, from someone with very poor veins (someone with a chronic condition, so they'd been stuck on a regular basis their whole life) and I know I made him wince. It doesn't feel great, knowing that someone with more experience could have done it perfectly and painlessly. Still, I have to learn somehow, and if I start now, I have another three years to perfect my technique before I'm expected to do it on a near-death patient in the middle of the night with no back up. Now that's when I'll really be nervous!

I did it! Straight in, no having to wiggle it around - got it first time and didn't seem to hurt my patient (though he was only semi-conscious). I was astounded! Beginner's luck I did my first cannulation today too, which also went more smoothly than expected, although I did get a fair bit of help from the junior doctor - not entirely sure how I'll manage with two hands rather than four! Just need to find more people who are willing to let me stick needles in them now

Congrats on your arterial stick going well. Nicely done. I think I want to be semi-conscious if I ever need one though, or maybe I'll come find you.

Cannulation? The only think I can think of is a nasal-pharyngeal airway which I've heard called a nasal cannula but they're pretty easy to put in, only two hands needed (though so far I've only ever done it on practice dummys). A funny story a nurse/EMT was telling at a recert course I took last fall. Sometimes they get drug overdose patients who fake being unconscious so they don't have to talk to the cops. He just puts a nasal cannula in them; they find out real quick if the patient is faking unconsciousness.

Cannulation = IV access - not sure what you call it across the pond. I have a funny feeling I've seen them called catheters on US TV shows - though here that term is almost universally taken to refer to urinary catheters.

I've seen nurses loudly announce the need for the "rectal medicine" over patients suspected of faking seizures - funny how many of them stop fitting at that point, or as soon as their pants get pulled down!

I was just at a wilderness/travel medicine talk tonight (malaria was tonight's topic) and the speaker kept talking about giving medicine parentally. This made no sense to me; you give the drugs to the patient's parents who give it to the patient? Eventually I saw on a slide that he was actually saying "parenteral". It was still a new word to me but from context I figured out he meant, via IV.

I just checked with wikipedia and I see that parenteral doesn't mean just IV but a whole variety of injection methods.

Cannulation may well be the term here too, I don't have a lot of contact with IVs, but mostly I've heard people talk about "putting in an IV".

So have you learned intraosseous administration of drugs? Apparently the paramedics around here think it's just the neatest thing. They have some sort of device they slap on your sternum and it just drills into the bone to access the marrow. They say it's very quick and relatively painless. I believe quick but it sounds excruciating.

Oh, catheters here also commonly refers to urinary catheters.

> Oh, catheters here also commonly refers to urinary catheters.

Hmm...so I wonder what they do in the cardiac catheterization lab at the hospital....

Put in stents? Yeah, good point. Catheter is a rather generic term for many sorts of tubes.

> I was just at a wilderness/travel medicine talk tonight (malaria was
> tonight's topic) and the speaker kept talking about giving medicine
> parentally. This made no sense to me; you give the drugs to the patient's
> parents who give it to the patient? Eventually I saw on a slide that
> he was actually saying "parenteral". It was still a new word to me
> but from context I figured out he meant, via IV.

I love that In my first year, we had a lecturer who kept talking about how humans were similar to many other "fishes" when it came to childbirth (causing widespread confusion). It took a long time for me to realise he was actually saying "species".

How much involvement do you have with wilderness/travel medicine? A friend of mine is desperate to do pre-hospital medicine, and in particular wants to do expedition medicine or air ambulance/mountain rescue type work. She's trying to track down organisations (anywhere in the world) at the moment that she can contact about doing an elective placement next year, but isn't getting a great response from anyone at the moment. Most of my friends want to do very acute medicine (unlike me), which is sadly hugely competitive.

> So have you learned intraosseous administration of drugs?

I've come across it, but I haven't seen it done. I think it's quite common in children's hospitals here, but less so in adults. I have seen bone biopsies taken though, which involves boring something that looks a lot like a narrow apple corer into someone's pelvic bones. *That* was definitely excruciating!

I've been involved in the past with three different volunteer search and rescue teams. It was my interest in search and rescue and wilderness travel that brought me to an interest in medicine and getting my EMT certification. However, I'll say that the search and rescue I've been involved with has used very little in the way of medical skills. We were volunteers, mainly used for running trails, carrying people out on stretchers, and having the skills and equipment to be able to go into the wilderness or mountains and not create additional victims. Obviously there are more medically oriented SAR organizations but I've never been a part of one.

I assume your friend knows about Doctors without Borders. The doctor teaching most of these wilderness medicine lectures I've been attending is the director of our local air ambulance, DHART. Dartmouth-Hitchcock is certainly a teaching hospital, being affiliated with Dartmouth Medical School, but I don't know if DHART takes internships like your friend is looking for. He's also been involved with clinics in Africa and Costa Rica. I can ask him if he knows places your friend should contact. I won't be seeing him for a few weeks as he's on vacation and then I'm traveling but I'm happy to ask for her.

Sorry for the slow reply - my placement has been hectic lately!

>The doctor teaching most of these
> wilderness medicine lectures I've been attending is the director of
> our local air ambulance, DHART.

I know that air ambulance work is what she's most interested in at the moment - she's been trying to contact UK based air ambulance services, but without much success. She does know of another student who has managed to arrange a placement with them, but that seems to have been by virtue of a few strings pulled by "daddy"! I imagine it would be even harder to arrange something in the US because of the massive insurance problems that can arise, but it's always worth putting some feelers out...

> Dartmouth-Hitchcock is certainly a teaching hospital, being affiliated
> with Dartmouth Medical School, but I don't know if DHART takes internships
> like your friend is looking for. He's also been involved with clinics
> in Africa and Costa Rica. I can ask him if he knows places your friend
> should contact. I won't be seeing him for a few weeks as he's on
> vacation and then I'm traveling but I'm happy to ask for her.

It would be fantastic if you could - we've got to wait a while before we even know which rotation we're on but she'd really appreciate any leads that she can get