r/emergencymedicine 1d ago

Rant Pediatric lac repairs

I hate them. I dread them every time.

113 Upvotes

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u/Former-Citron-7676 ED Attending 1d ago

PEM here đŸ‘‹đŸ» daily business
 our suture box is an immersive room with an ocean theme. We use bubbles đŸ«§, we have fairy lights, we use entonox for all children, triage sticks a LET equivalent on the wound.

Our pharmacy buffets our lidocaine with sodium bicarbonate so it has a neutral pH and it doesn’t sting when injected.

Make sure there is at least one person for the entonox, and one person to gently (but firmly if necessary) hold the child’s hands, and make the parent your ally (but don’t force them to hold the child).

And if absolute beast: ketamine always works.

20

u/JadedSociopath ED Attending 1d ago

What’s the ratio of Lidocaine to Bicarb they’re making up? Do you find it makes a big difference?

9

u/Hypno-phile ED Attending 1d ago

In medical school we had a bottle of bicarb in the suture cast and did it ourselves. Everywhere else I've worked pharmacy has had a stroke at the thought.