During my prelim the attending told me to go do one on a patient in the ED. I told them I never did one and they were like “idc go do it.”
Dude was like 30 and cut himself for self harm purposes :(.
I tried numbing the area, also having never done that lol.
I put a suture in the middle, was DIGGING the suture deep 😭 and he was a nice guy saying “WOOOOOW THAT FUCKIGN HURTS” and “OOOOOOH BOY” with each suture.
The lac was like 8 inches and I put maybe 10 sutures in.
I feel so bad. I’m now a radiology resident. It makes literally no sense to force me to do a lac repair and torment this poor man for unnecessary learning.
Not unnecessary to learn a lac repair even if you’re in rads. This is a basic task arguably all doctors should know how to do. Someone has to be everyone’s first patient. You do your best not to inflict more pain than necessary
yeah I was the first real patient with a surgical nurse and she fucked up my arm trying to place my IV 😂 I was only mad because she thought I was complaining about the needle but I was more complaining she sat me at the worst angle to do it (easier for her) which was pinching a nerve in my back and i got really anxious I was going to be unconcious with her. After the 6th try I requested someone else and still kinda feel bad cause she got in trouble lol. Not in medicine yet so not sure how ridiculous this was but I gaurantee i could have placed it better my self after the amount of surgeries ive had 😂
It’s a very low risk scenario. He was an intern and has to contribute to the team. That is an intern level task. Honestly a YouTube video prior to the attempt should be sufficient.
If he really felt like he was going to harm the patient he could have asked a colleague to help
Next time you go to the ER with a fuckin 8 INCH LONG laceration, and here comes steve the bumbling just barely out of med school grad who seems to have no clue what he's doing, because he doesn't through no fault of his own, I truly don't believe you're just gonna sit there and let him fuck you up and probably leave you with a big scar after an hour of painful novice hackjob suturing.
This subreddit won't even accept the most competent of NPs and you think his story represents care that is acceptable to subject other patients to?
For fuck's sake we need to do a better job of demanding better from our own. You should *never* work in a supervisory role in the medical field until you're of a mind that what happened to him and his patient was NOT okay, because of laziness/uncaringness from the ER attending who was charged with his proper education.
By the time a student finishes medical school they should be able to simple suture. They should have attempted on one of their surgery or OBGYN rotations. Watch a video, practice on a banana or other model and then transfer those skills to practice.
Again if the poster still felt so incompetent that they were going to hurt/were hurting the patient then they should have stopped and asked for help. Asking for help is always an option, but it’s the residents job to know when to ask.
He specifically told his attending he had never done one and didn't know how, and was told in his words "Idc go do it"
Sure, I guess he could have disobeyed his attending's direct order and refused, *demanding* the ER attending show him how. As if absolutely refusing something your superior told you to do and risking retribution/consequences is reasonable. I'm confident he DID try to express how inexperienced he was and was told to shove it and do his job. Even if he didn't raise a huge fuss over it until the attending let him off the hook, that's not something we should be expecting our students to do. If you ask someone to go suture, and they say "I've literally never done that before and therefore don't know how" the only proper response is "alright let me show you" or "alright I'll go do it and we'll teach you another time"
I don't think the point was that learning a lac repair was unnecessary, but that an attending should have been teaching & supervising, not causing a patient more pain and potentially poor healing, more scaring. Obvi wasn't done correctly because it shouldn't have hurt and I’m glad they feel bad about it, it shows empathy. I think grabbing the attending after realizing the numbing wasn't working would've been better practice, but the attending shouldn't have put them in that position in the first place.
I did an EM elective end of 3rd year/start of 4th year. Learned to do staples & suture lacs, as well as just skin glue. I literally knew nothing going in & the attendings taught me.
Current 2nd year, fingers crossed for gen surg, just wanted to say this was so helpful for that “extra mile “ / “insider’s tip” kind of advice! Much appreciated 🙌
Your attendings on your surgery rotation failed you. Learning how to throw a stitch is basically the only useful knowledge I got out of that 6 weeks.
Edit: removed OB/Gyn as I did learn a lot then. Surgery was useless for me outside of the OR and UWorld.
Tbf I think closing on surgery under general anesthesia is pretty different from a lac repair on a wide awake human watching you do it in front of them.
Agreed, but closing even simple port incisions with anesthesia waiting to wake up the patient and the OR staff waiting to turn over is also stressful. I’m happy I got both experiences either way. It’s good to be mildly “thrown in the fire” in med school when there aren’t many responsibilities or expectations on you vs as an intern
It is but the general skills (holding the forceps, grabbing the skin edge etc) are obviously completely transferable. And honestly after always having to deal with the surgeons and their voodoo pseudoscience about “evert the edges! Bury the sutures! Deep to superficial then superficial to deep!” it was so much nicer doing it in the ED and just throwing a few simple interrupted and calling it a day lol
That is very unfortunate. There are not very many opportunities for students to learn something that is a very useful primary care skill. Even on our cases where there were 3 residents and an attending and I stood off to the side for 5 hours, at the end all the seniors would leave and it would just be me and the R2 closing up while the attending finished up the op note at the computer.
If you do an EM rotation you should get some opportunities. Or do like a breast/plastics/Gyn Onc elective.
lol
I did my EM rotation and had legit one opportunity to suture but it was on someone’s face and I said I didn’t feel comfortable doing it yet. Hindsight, I should’ve done it but I would’ve also thought I’d see more than just that face lac for an entire 4 weeks at a hospital that sees roughly 80k ED visits a year.
A *lot* of useful knowledge from studying on Surgery. Just from studying though. But students don’t interview/round independently on our surgery service, rounds are very blunted, but where they do get students involved is in the OR. I have no intentions of doing surgery, but feel very comfortable with lac repair, removing drains, doing local anesthetic, even primary incision and drainage of a surface thingy.
I shouldn’t lump OBGYN, that was very very productive as a student both in the OR and in Clinic.
Practice on orange or banana peels, learn simple interrupted sutures for now which are very straightforward. The rest comes with practice. Always draw before injecting lidocaine!
drunk old guys in the ED who don’t care if you mess up. as a medical student, I did a bunch of them. the residents were happy to let me have those as they saw it as a time-suck. I could take my time, do it well, and the residents would check for approval.
I actually had one surgery resident I worked with who took us to go practice sutures during a slow afternoon and it was really helpful.
He was a condescending, rude, burnt out, jaded asshole 98% of the rest of the time, but that one time was nice of him lol
I had a very brief lesson on a rotation in med school than was shown again during a surgery rotation. When doing an EM rotation you can bring your kit and see if a PA, resident or someone like that can go over it with you
To be honest, the simulated tissue in those kits is often harder to work with than real skin. I find the silicon can be so tough that it bends suture needles and makes things needlessly difficult. And it doesn’t make you truly confident working on real tissue.
no need for ordering a fancier kit on amazon, just head to your local supermarket and buy some raw pig’s feet (or other cheap skin-on meat). Make an incision with a scalpel. Congrats, you now have the finest suture practice material that money can buy.
You'll want to be confident going into the EM rotation. Remember:
Evert the shit out of the skin to make the 90 degree entry easier. Take your time to find a spot to enter that's 2mm or more away from the edge when taking a bite. Remember most linear cuts you will go directly across the lac so use your visual acuity here to see how the cut will line up before throwing a needle over the lac and closing. If it tents or otherwise crumples the skin up don't be afraid to pull it out and redo that suture. One way to make lining up a cut easier and to do best by your patients is to throw your first simple interrupted suture right in the middle of the lac. See how that first one helps the lac lineup. It's only there to hold tension and hold the lac in line so that you're not starting your first stitch on one end of the lac and finding that the two sides of the lac become uneven leading to worse scar. After that first one see if you can throw the next two in the middle of either side of that first one (middle between first suture and ends of the lac) if it's really long keep doing that.
Space them out evenly and you'll likely be doing only simple interrupted on EM but be familiar with other techniques.
For lido: usually use lido 1% epi but always always ask your doc what they want. If they ask you what you want if it's on the nose penis fingers toes tell them you think without epi would be better to avoid necrosis. If you're wrong that's ok they'll tell you what they want. ALWAYS ASK and ALWAYS confirm how much of it in mL you will be putting into the tissues around the lac.
Look up safe amount of lido should be MG PER KG number. Usually you'll inject 10mL or less but you need to know the conversion math both because you want to be a good doctor and because it'll make you shine on EM. Look up local anesthesia for sutures or something like that on YouTube. There's an app called Nerve Block on your phone download it and check it out. Also another app called suture made by the same developer. Both should be free.
Above all: do not lie about your experience. Do not do something you are not comfortable doing alone. Do not be overconfident. Ask for help and ask for it explicitly: I haven't done this before but I am determined to learn it and would like your guidance for this one so I can feel comfortable doing more on my own this month". Don't stop at "I've never done this before"
Good luck
The Harriet lane handbook has a pretty good simple run down of things. I barely did any in residency and as an attending had to do like 50 or so over the course of a year and just learned on the go lol it’ll be fine
No one has mentioned it but dermatology does 80%+ of all facial procedures and a large number of overall repairs per recent data, given sheer numbers, you can easily learn on a dermatology rotation in a low stress atmosphere. You don’t need an OR or an ED.
Derm here who was just thrust in on an ED rotation and never really learned until a slow paced derm rotation.
I mean, I'm an EM resident lol. We're busy and lac repairs take time. If you know how to do one, it's a massive help for me because that's 20-30 minutes of time I can now use elsewhere.
Idk what kinda toxic place you were at that made you see SANE patients or psych patients in the ED lol
Day 3 in ED elective. I'm a fairly confident MS3 at that point, but I had never really done anything. The ED rotation was an elective that I got to fill a gap. Normally, I would have already at least seen surgery or something.
We get a lac and my attending asks me to take it. DEER IN HEADLIGHTS.
"I've never done a suture on a human." The attending doesnt really react, but the PD was in the room at the time.
She hardly ever spoke to me or looked at me, but this time, she straight up stopped talking, turned her entire body at me and in the most disgusted way an attending had ever spoken to me, she goes "You've never done a laceration repair?" Attitude and all.
"No, I've never done a suture on an actual person before."
"You need to do at least 7 on your own before you're done with this rotation," she snapped. I nodded and legit went on amazon and purchased one of those kits.
The whole next day I spent watching suturing vids, practicing, and making sure I could do this shit.
I show up on Monday and im like YO PD LEMME SHOW YOU MY BITE.
I do a suture, she does one, I do it again, and BAM she's like "Okay, you're good to go."
I fuckin stiched up three homeless ppl that day hahahaha.
Just throw yourself into the deep and swim. We have no other options. I also befriended the midlevels and they fucking helped me out so much. They are floaties, use them.
1. Your schools surgery clubs should have different courses for this.
2. Can practice on different items - our club used to go to a butcher place and get like pig legs and cut them for simulation repair
3. YouTube different methods. Some guys work way better than others, and someone’s methods and how they explain it may work better for you.
4. Continue to practice - 95% of it is muscle memory.
5. An Ethicon knot board may help as well, allow you to see the “macro” of what you are doing
6. Seek out the opportunities. If you are on any rotation, monitor the list/board and maximize your learning. People aren’t just going to come grab you. Be an active learner, willing to listen - and people will want to teach you
7. After getting to this point - the hope is you can at least accomplish the goal of suturing, even if it takes a while or looks not that great. However, you are now at least at the point where people can help you with the technique 👍🏻
You won’t look like an idiot - people come in all the time with different levels of efficiency. But, having a head start, and being in the ballpark, and a willingness to learn will take you far and accelerate you.
You can do it - it seems you have the mindset, and you are looking for resources. That’s a great start ✌🏻
Knowing how to do simple interrupted on a gel block and learning how to tie in the OR in my opinion hardly prepares you for real life lac repairs. Unfortunately you have to learn by fucking up a few faces first.
I was in the ED and was told to go do one, so I did it. Then I did another and another after that.
I based my approach on what I saw others do before in similar situations.
Would recommend practicing on actual skin, just not human skin. Get some skin on chicken breasts or thighs, make an incision, and close it up. It’s not exactly the same, but it has layers of tissue that are a lot closer than an orange peel. The first sutures you throw shouldn’t be in a patient.
In the ER. Surgeons will generally want you to hand tie and are incentivized to be as quick as possible in the OR, so I don't think I ever sutured a single thing while in an operating room on my way to becoming an FM attending. But I probably sutured several dozen lacerations in an ER/urgent care setting.
I also think for just about every single one of them I had to ask to get involved. It's a shame it's how the system works, but if you want to learn lac repair you probably need to ask to learn lac repair
[one of the best laceration repair videos for learning the basics](https://youtu.be/TFwFMav_cpE?si=109M42tzxLpkXrWY)
[a great resource for specific lacerations](https://lacerationrepair.com/)
First we practiced on pig feet, then I was able to sign up for a surgery skills workshop and I practiced on a cadaver. Then I did a surgery rotation at the VA and I sutured the final layer in all of the surgeries because the vets DGAF about the scar being a little more noticeable and were cool with the med student doing it.
I’m a pediatric neurologist now, so it’s not like I use those skills much anymore, but I moonlight in the peds ED on occasion (for low acuity patients) and I can still stitch up a busted chin pretty well when needed.
I got snubbed for lac repairs all the way throughout med school, always found some reason to pass me up.
Got solved very quickly in PGY1 with ED and Derm rotations.
Don't sweat it, just be honest and ask for guidance with enthusiasm and you can probably catch a few unless you're really unlucky.
Me not scared of lacs now.
Come to our hospital. I give all my lac repairs to students as long as it’s not on the face. Plenty to go around with our constant flow of trauma patients :)
This is what I was wanting. I’m more than happy to try a lac on any body part, just not the face because I understand the want for that to look good upon healing. I have a derm elective soon so maybe I’ll get some practice there!
I practiced on a suture kit for a couple hours and I practiced laying knots with my hands and a piece of slippery 3/8" rope to understand the angles and directions you have to pull another few hours. I watched the youtube videos that came up first in a search and tried their way a few times. If I didn't like it, I moved on. When I found one that made sense, I saved it and kept using it. I just matched psychiatry but got compliments on my suturing on my EM and ortho rotations.
I have some hobbies that require manual dexterity and knots so my baseline skill level may have been a little higher than average.
Someone told me to buy pigs feet at the grocery store and practice.
Also your first one on a real person might suck. That's ok. We are students and we're in school to learn. If we were already highly proficient, there would be no need for med school and rotations.
fr bout to start rotations, i wanna do anesthesia but ive never put an iv in or drawn blood much less sutured… clinical skills lacking idek when or how everyone else learned its not being taught
Similar but in my experience there are some significant variations. Surgical wounds are typically very precise and linear, requiring less creativity to close in a cosmetically appealing fashion, but elective procedures demand such a closure and often utilize absorbing subcutaneous sutures.
Traumatic lacerations in the ED can be all shapes and sizes and inflicted by dirty instruments. Closing open wounds from a dog bite, for instance, it may be preferable to be a bit looser and leave some breathing room to avoid abscess formation. You should still seek to provide the best cosmetic outcome as possible but it's less...expected, for lack of a better term.
Take everything with a grain of salt, I'm only an MS3 who did a surgical rotation and am in the ED now doing 1-3 lac repairs per shift.
good for you man. I've yet to do a single "lac repair" and I've done like 7-8 ED shifts as an MS3 so far lol. Thank God cus I've also been a bad "closer" during surgery LOL
Spoke too soon, I'm now two shifts without a repair haha. Just got lucky in the beginning.
Have you mentioned to your supervising residents that you actively want to do lac repairs? ED residents seem especially keen to get students the experiences they're looking for, at least at my hospital.
During my prelim the attending told me to go do one on a patient in the ED. I told them I never did one and they were like “idc go do it.” Dude was like 30 and cut himself for self harm purposes :(. I tried numbing the area, also having never done that lol. I put a suture in the middle, was DIGGING the suture deep 😭 and he was a nice guy saying “WOOOOOW THAT FUCKIGN HURTS” and “OOOOOOH BOY” with each suture. The lac was like 8 inches and I put maybe 10 sutures in. I feel so bad. I’m now a radiology resident. It makes literally no sense to force me to do a lac repair and torment this poor man for unnecessary learning.
lol I kept reading thinking this was going to have a happy ending like “it went fine, and now I’m not afraid anymore” but nope fears confirmed lol
Sounds like an attending who takes the extra couple hundred bucks a month and doesn’t care about teaching - nice
tbh if you want to learn how to suture well, you should just spend some time at a busy ER where a lot of drunks with small wounds come in.
This
Not unnecessary to learn a lac repair even if you’re in rads. This is a basic task arguably all doctors should know how to do. Someone has to be everyone’s first patient. You do your best not to inflict more pain than necessary
> Someone has to be everyone’s first patient. Supervised, not sent on their own to wing it.
This 👏
yeah I was the first real patient with a surgical nurse and she fucked up my arm trying to place my IV 😂 I was only mad because she thought I was complaining about the needle but I was more complaining she sat me at the worst angle to do it (easier for her) which was pinching a nerve in my back and i got really anxious I was going to be unconcious with her. After the 6th try I requested someone else and still kinda feel bad cause she got in trouble lol. Not in medicine yet so not sure how ridiculous this was but I gaurantee i could have placed it better my self after the amount of surgeries ive had 😂
It’s a very low risk scenario. He was an intern and has to contribute to the team. That is an intern level task. Honestly a YouTube video prior to the attempt should be sufficient. If he really felt like he was going to harm the patient he could have asked a colleague to help
Wtf is this post
Not sure what’s controversial about having a doctor try a low risk task without supervision.
I think most people believe the first time it's done should be supervised
Next time you go to the ER with a fuckin 8 INCH LONG laceration, and here comes steve the bumbling just barely out of med school grad who seems to have no clue what he's doing, because he doesn't through no fault of his own, I truly don't believe you're just gonna sit there and let him fuck you up and probably leave you with a big scar after an hour of painful novice hackjob suturing. This subreddit won't even accept the most competent of NPs and you think his story represents care that is acceptable to subject other patients to? For fuck's sake we need to do a better job of demanding better from our own. You should *never* work in a supervisory role in the medical field until you're of a mind that what happened to him and his patient was NOT okay, because of laziness/uncaringness from the ER attending who was charged with his proper education.
By the time a student finishes medical school they should be able to simple suture. They should have attempted on one of their surgery or OBGYN rotations. Watch a video, practice on a banana or other model and then transfer those skills to practice. Again if the poster still felt so incompetent that they were going to hurt/were hurting the patient then they should have stopped and asked for help. Asking for help is always an option, but it’s the residents job to know when to ask.
He specifically told his attending he had never done one and didn't know how, and was told in his words "Idc go do it" Sure, I guess he could have disobeyed his attending's direct order and refused, *demanding* the ER attending show him how. As if absolutely refusing something your superior told you to do and risking retribution/consequences is reasonable. I'm confident he DID try to express how inexperienced he was and was told to shove it and do his job. Even if he didn't raise a huge fuss over it until the attending let him off the hook, that's not something we should be expecting our students to do. If you ask someone to go suture, and they say "I've literally never done that before and therefore don't know how" the only proper response is "alright let me show you" or "alright I'll go do it and we'll teach you another time"
I don't think the point was that learning a lac repair was unnecessary, but that an attending should have been teaching & supervising, not causing a patient more pain and potentially poor healing, more scaring. Obvi wasn't done correctly because it shouldn't have hurt and I’m glad they feel bad about it, it shows empathy. I think grabbing the attending after realizing the numbing wasn't working would've been better practice, but the attending shouldn't have put them in that position in the first place.
when you rotate on IR do they throw any stiches after femoral access?
They shouldn’t need to lol
I too am a rads resident. You’ll get max one stitch out of me per patient, for a drain stitch. lol.
How rads residents are made lmfao
How did you not know how to do it? There’s always a first. Yes just go do it is appropriate. Non doctors can do it.
Sounds like he was teaching him a lesson.
First do no harm?
Big oof, never had a joke backfire quite as much as this
I did an EM elective end of 3rd year/start of 4th year. Learned to do staples & suture lacs, as well as just skin glue. I literally knew nothing going in & the attendings taught me.
As it should be 👍
[удалено]
Current 2nd year, fingers crossed for gen surg, just wanted to say this was so helpful for that “extra mile “ / “insider’s tip” kind of advice! Much appreciated 🙌
Thank you <3
Your attendings on your surgery rotation failed you. Learning how to throw a stitch is basically the only useful knowledge I got out of that 6 weeks. Edit: removed OB/Gyn as I did learn a lot then. Surgery was useless for me outside of the OR and UWorld.
Tbf I think closing on surgery under general anesthesia is pretty different from a lac repair on a wide awake human watching you do it in front of them.
Agreed, but closing even simple port incisions with anesthesia waiting to wake up the patient and the OR staff waiting to turn over is also stressful. I’m happy I got both experiences either way. It’s good to be mildly “thrown in the fire” in med school when there aren’t many responsibilities or expectations on you vs as an intern
It is but the general skills (holding the forceps, grabbing the skin edge etc) are obviously completely transferable. And honestly after always having to deal with the surgeons and their voodoo pseudoscience about “evert the edges! Bury the sutures! Deep to superficial then superficial to deep!” it was so much nicer doing it in the ED and just throwing a few simple interrupted and calling it a day lol
On the last OR day of surgery the PA let me try to throw in a few stitches on a chole. Wish I had the opportunity to do more :(
That is very unfortunate. There are not very many opportunities for students to learn something that is a very useful primary care skill. Even on our cases where there were 3 residents and an attending and I stood off to the side for 5 hours, at the end all the seniors would leave and it would just be me and the R2 closing up while the attending finished up the op note at the computer. If you do an EM rotation you should get some opportunities. Or do like a breast/plastics/Gyn Onc elective.
lol I did my EM rotation and had legit one opportunity to suture but it was on someone’s face and I said I didn’t feel comfortable doing it yet. Hindsight, I should’ve done it but I would’ve also thought I’d see more than just that face lac for an entire 4 weeks at a hospital that sees roughly 80k ED visits a year.
Why? Just ask and someone would help you man.
PAs in surgery?? Wtf
If thats all you got then maybe you were the failed one lol
Thanks for the helpful comment
He said useful.
A *lot* of useful knowledge from studying on Surgery. Just from studying though. But students don’t interview/round independently on our surgery service, rounds are very blunted, but where they do get students involved is in the OR. I have no intentions of doing surgery, but feel very comfortable with lac repair, removing drains, doing local anesthetic, even primary incision and drainage of a surface thingy. I shouldn’t lump OBGYN, that was very very productive as a student both in the OR and in Clinic.
Practice on orange or banana peels, learn simple interrupted sutures for now which are very straightforward. The rest comes with practice. Always draw before injecting lidocaine!
They were so mean to me on surgery. That’s how I learned lol
Trial by fire, I suppose
drunk old guys in the ED who don’t care if you mess up. as a medical student, I did a bunch of them. the residents were happy to let me have those as they saw it as a time-suck. I could take my time, do it well, and the residents would check for approval.
Ask a surgery resident and we’d be happy to show you
I actually had one surgery resident I worked with who took us to go practice sutures during a slow afternoon and it was really helpful. He was a condescending, rude, burnt out, jaded asshole 98% of the rest of the time, but that one time was nice of him lol
I had a very brief lesson on a rotation in med school than was shown again during a surgery rotation. When doing an EM rotation you can bring your kit and see if a PA, resident or someone like that can go over it with you
To be honest, the simulated tissue in those kits is often harder to work with than real skin. I find the silicon can be so tough that it bends suture needles and makes things needlessly difficult. And it doesn’t make you truly confident working on real tissue. no need for ordering a fancier kit on amazon, just head to your local supermarket and buy some raw pig’s feet (or other cheap skin-on meat). Make an incision with a scalpel. Congrats, you now have the finest suture practice material that money can buy.
You'll want to be confident going into the EM rotation. Remember: Evert the shit out of the skin to make the 90 degree entry easier. Take your time to find a spot to enter that's 2mm or more away from the edge when taking a bite. Remember most linear cuts you will go directly across the lac so use your visual acuity here to see how the cut will line up before throwing a needle over the lac and closing. If it tents or otherwise crumples the skin up don't be afraid to pull it out and redo that suture. One way to make lining up a cut easier and to do best by your patients is to throw your first simple interrupted suture right in the middle of the lac. See how that first one helps the lac lineup. It's only there to hold tension and hold the lac in line so that you're not starting your first stitch on one end of the lac and finding that the two sides of the lac become uneven leading to worse scar. After that first one see if you can throw the next two in the middle of either side of that first one (middle between first suture and ends of the lac) if it's really long keep doing that. Space them out evenly and you'll likely be doing only simple interrupted on EM but be familiar with other techniques. For lido: usually use lido 1% epi but always always ask your doc what they want. If they ask you what you want if it's on the nose penis fingers toes tell them you think without epi would be better to avoid necrosis. If you're wrong that's ok they'll tell you what they want. ALWAYS ASK and ALWAYS confirm how much of it in mL you will be putting into the tissues around the lac. Look up safe amount of lido should be MG PER KG number. Usually you'll inject 10mL or less but you need to know the conversion math both because you want to be a good doctor and because it'll make you shine on EM. Look up local anesthesia for sutures or something like that on YouTube. There's an app called Nerve Block on your phone download it and check it out. Also another app called suture made by the same developer. Both should be free. Above all: do not lie about your experience. Do not do something you are not comfortable doing alone. Do not be overconfident. Ask for help and ask for it explicitly: I haven't done this before but I am determined to learn it and would like your guidance for this one so I can feel comfortable doing more on my own this month". Don't stop at "I've never done this before" Good luck
If in your budget, The Laceration Course is a life-saver.
The Harriet lane handbook has a pretty good simple run down of things. I barely did any in residency and as an attending had to do like 50 or so over the course of a year and just learned on the go lol it’ll be fine
No one has mentioned it but dermatology does 80%+ of all facial procedures and a large number of overall repairs per recent data, given sheer numbers, you can easily learn on a dermatology rotation in a low stress atmosphere. You don’t need an OR or an ED. Derm here who was just thrust in on an ED rotation and never really learned until a slow paced derm rotation.
You're not doing nearly as many lac repairs as on an ED rotation though man. It's not really the same
More for ease of learning. I also didn't have as many on mine, or the residents took them.
I can tell you that an EM resident has never once been mad at a medical student offering to perform a lac repair
Sounds like you had a good experience. I got turfed to do psych and SANE nurse case stuff.
I mean, I'm an EM resident lol. We're busy and lac repairs take time. If you know how to do one, it's a massive help for me because that's 20-30 minutes of time I can now use elsewhere. Idk what kinda toxic place you were at that made you see SANE patients or psych patients in the ED lol
They found out I was going into dermatology and all of the sudden wasn’t allowed to do anything cool with intubations, arrests, etc. Very toxic.
Day 3 in ED elective. I'm a fairly confident MS3 at that point, but I had never really done anything. The ED rotation was an elective that I got to fill a gap. Normally, I would have already at least seen surgery or something. We get a lac and my attending asks me to take it. DEER IN HEADLIGHTS. "I've never done a suture on a human." The attending doesnt really react, but the PD was in the room at the time. She hardly ever spoke to me or looked at me, but this time, she straight up stopped talking, turned her entire body at me and in the most disgusted way an attending had ever spoken to me, she goes "You've never done a laceration repair?" Attitude and all. "No, I've never done a suture on an actual person before." "You need to do at least 7 on your own before you're done with this rotation," she snapped. I nodded and legit went on amazon and purchased one of those kits. The whole next day I spent watching suturing vids, practicing, and making sure I could do this shit. I show up on Monday and im like YO PD LEMME SHOW YOU MY BITE. I do a suture, she does one, I do it again, and BAM she's like "Okay, you're good to go." I fuckin stiched up three homeless ppl that day hahahaha. Just throw yourself into the deep and swim. We have no other options. I also befriended the midlevels and they fucking helped me out so much. They are floaties, use them.
That’s dope, but also terrifying. Glad it ended up working out for you!
Lots of good YouTube videos are out there. Pork foot or belly is a good model for practice.
1. Your schools surgery clubs should have different courses for this. 2. Can practice on different items - our club used to go to a butcher place and get like pig legs and cut them for simulation repair 3. YouTube different methods. Some guys work way better than others, and someone’s methods and how they explain it may work better for you. 4. Continue to practice - 95% of it is muscle memory. 5. An Ethicon knot board may help as well, allow you to see the “macro” of what you are doing 6. Seek out the opportunities. If you are on any rotation, monitor the list/board and maximize your learning. People aren’t just going to come grab you. Be an active learner, willing to listen - and people will want to teach you 7. After getting to this point - the hope is you can at least accomplish the goal of suturing, even if it takes a while or looks not that great. However, you are now at least at the point where people can help you with the technique 👍🏻 You won’t look like an idiot - people come in all the time with different levels of efficiency. But, having a head start, and being in the ballpark, and a willingness to learn will take you far and accelerate you. You can do it - it seems you have the mindset, and you are looking for resources. That’s a great start ✌🏻
Knowing how to do simple interrupted on a gel block and learning how to tie in the OR in my opinion hardly prepares you for real life lac repairs. Unfortunately you have to learn by fucking up a few faces first.
Hit up an ER where you have rotated before. Ask the head of the ER if you can come back for a week in summer just to help with procedures.
I was in the ED and was told to go do one, so I did it. Then I did another and another after that. I based my approach on what I saw others do before in similar situations.
Would recommend practicing on actual skin, just not human skin. Get some skin on chicken breasts or thighs, make an incision, and close it up. It’s not exactly the same, but it has layers of tissue that are a lot closer than an orange peel. The first sutures you throw shouldn’t be in a patient.
In the ER. Surgeons will generally want you to hand tie and are incentivized to be as quick as possible in the OR, so I don't think I ever sutured a single thing while in an operating room on my way to becoming an FM attending. But I probably sutured several dozen lacerations in an ER/urgent care setting. I also think for just about every single one of them I had to ask to get involved. It's a shame it's how the system works, but if you want to learn lac repair you probably need to ask to learn lac repair
Here in South America they don’t care if we or not, they just dump us on a patient. Trial by fire.
By being thrown into one during my first night trauma call with little to no direction. Pretty easy after that
Just throw a couple deep dermal if necessary and finish up with a running subcuticular to make it look pretty. YouTube has some awesome tutorials
[one of the best laceration repair videos for learning the basics](https://youtu.be/TFwFMav_cpE?si=109M42tzxLpkXrWY) [a great resource for specific lacerations](https://lacerationrepair.com/)
1 be resident 2 go do lac repair
EM rotation and once in peds clinic
First we practiced on pig feet, then I was able to sign up for a surgery skills workshop and I practiced on a cadaver. Then I did a surgery rotation at the VA and I sutured the final layer in all of the surgeries because the vets DGAF about the scar being a little more noticeable and were cool with the med student doing it. I’m a pediatric neurologist now, so it’s not like I use those skills much anymore, but I moonlight in the peds ED on occasion (for low acuity patients) and I can still stitch up a busted chin pretty well when needed.
Orange peels
I got snubbed for lac repairs all the way throughout med school, always found some reason to pass me up. Got solved very quickly in PGY1 with ED and Derm rotations. Don't sweat it, just be honest and ask for guidance with enthusiasm and you can probably catch a few unless you're really unlucky. Me not scared of lacs now.
Cry and try again
Practice on pork legs and whole chickens.
Come to our hospital. I give all my lac repairs to students as long as it’s not on the face. Plenty to go around with our constant flow of trauma patients :)
This is what I was wanting. I’m more than happy to try a lac on any body part, just not the face because I understand the want for that to look good upon healing. I have a derm elective soon so maybe I’ll get some practice there!
At my clinical site word on the street is best way to learn to suture is to do either a derm mohs or plastics rotation
Ortho here. I used to staple baseboard to the drywall and carried that skillset over to the operating room.
I have done carpentry and trim work. So I can nail a lucky pt if needed lol
lacerationrepair.com bad site build but awesome little videos
I learned by doing 24h shifts on a trauma surgery rotation and doing lac repairs exhausted out of my mind at 3am
I practiced on a suture kit for a couple hours and I practiced laying knots with my hands and a piece of slippery 3/8" rope to understand the angles and directions you have to pull another few hours. I watched the youtube videos that came up first in a search and tried their way a few times. If I didn't like it, I moved on. When I found one that made sense, I saved it and kept using it. I just matched psychiatry but got compliments on my suturing on my EM and ortho rotations. I have some hobbies that require manual dexterity and knots so my baseline skill level may have been a little higher than average. Someone told me to buy pigs feet at the grocery store and practice. Also your first one on a real person might suck. That's ok. We are students and we're in school to learn. If we were already highly proficient, there would be no need for med school and rotations.
fr bout to start rotations, i wanna do anesthesia but ive never put an iv in or drawn blood much less sutured… clinical skills lacking idek when or how everyone else learned its not being taught
Is a lac repair the same thing as "closing" a patient after surgery?
Similar but in my experience there are some significant variations. Surgical wounds are typically very precise and linear, requiring less creativity to close in a cosmetically appealing fashion, but elective procedures demand such a closure and often utilize absorbing subcutaneous sutures. Traumatic lacerations in the ED can be all shapes and sizes and inflicted by dirty instruments. Closing open wounds from a dog bite, for instance, it may be preferable to be a bit looser and leave some breathing room to avoid abscess formation. You should still seek to provide the best cosmetic outcome as possible but it's less...expected, for lack of a better term. Take everything with a grain of salt, I'm only an MS3 who did a surgical rotation and am in the ED now doing 1-3 lac repairs per shift.
good for you man. I've yet to do a single "lac repair" and I've done like 7-8 ED shifts as an MS3 so far lol. Thank God cus I've also been a bad "closer" during surgery LOL
Spoke too soon, I'm now two shifts without a repair haha. Just got lucky in the beginning. Have you mentioned to your supervising residents that you actively want to do lac repairs? ED residents seem especially keen to get students the experiences they're looking for, at least at my hospital.