…as long as it gives you dimes and a nickel on the way out” –Physician guest speaker at SJCME.
Xylocaine with epi has been shown in studies to be nearly as safe as plain xylocaine… however, my instructor strongly urges us not to use it unless absolutely necessary due to the risk of necrosis, especially on fingertips and toes. 2% lidocaine is perfect for adults, no more than 1% for children. A tourniquet can be left on for approx 10 minutes or less to suppress bleeding in lieu of epi. Too much xylocaine can be toxic– 3mL is generally sufficient. This is VERY important in children!
Pig feet are an awesome learning tool for suturing. 6.0 thread is just about the tiniest needle imaginable and should be reserved for areas such as the face. Your sutures should be spaced apart by approximating the distance from the former suture by 1/2 the width of your previous sutures.
Punch biopsies look like you literally used a hole puncher… but you don’t. It’s this very unsophisticated (yet effective) looking tool that you twist into the skin (using local anesthetic). You need just the tiniest amount of subcutaneous fat (very tiny) for the pathologist to estimate wound depth. Any deeper and you’re going to have increased bleeding that may require stitching. The wound is closed with silver nitrate. If it requires suturing, you have to adjust the wound to make elliptical shape for closure.
If you have MDConsult, 5 Minute Consult, Ferri’s advisor, etc be sure to check their sites for instructional videos. I know 5 minute consult has excellent ones to review procedures Practice, practice, practice.
I learned much more in class and will add as I go along… for now, I’m spending my vacation in Maine with my nose in textbooks!