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I’m a PA who has been working in the ED for 6+ years. First of all, I was happy to know that I’m doing most things right when it comes to suturing! I’ve found that EMLA and LET dont seem to work very well (although I will try LET directly in the wound.) I’ve has some success with soaking a 4x4 in topical 4% lidocaine and placing that in the wound for about 15-20 minutes, or dripping the normal 1% lidocaine in the wound before I inject the edges. At one shop I worked at, we were using intranasal Versed at 0.4 mg/kg on our pediatric patients to relieve anxiety and to use the amnesia properties to our advantage. It was a battle at first, convincing nursing staff that this is not conscious sedation and can be done in fast track with no monitors. Thanks for a great podcast and I look forward to part II!
What you do matters.