[UMTXRN]

I have a quick question. I'm a new grad with very little ER experience. I have been working with a Doc who has done several things that I'm concerned about, but I'm not sure if I should be.
First question, Don't physicians normally use lidocaine before applying sutures and or staples?
Second, Advice please. This is a tiny hospital, if I had issues with this guy, what is the BEST way to go about getting things changed without everyone knowing I was the one reporting it. Has anyone else been through a similar situation?

[rjflyn]

Typically yes lidoicaine is used to numb lacerations before clouser. That said I can say it isnt always used. Iv'e seen docs not use it on multiple occasions. Generally when they dont use it it is a laceration that is only going to take one or 2 sutures to close. I dont know if you have ever had lidiocaine or not but it in and of itself hurts, not just a little sting like we tell patients- it worse than any bee sting I have ever had.

Personally having worked in emergency medicine for the last 16+ years most ED doctors are very approachable and willing to pass on their knowledge- so I would ask why he doesnt use lidocaine on a particular wound.

Rj

[purplemania]

Do you have a preceptor? Can you talk to your charge nurse or nurse manager? You need guidance in learning the difference between practice and policy. Once you have determined that someone's practice is not according to policy, then you should inact the chain of command, which may include "writing up" the physician. If you approach the topic as a learning experience for you, then people should not be offended. Also, you are going to P--- people off over something, someday, so it might as well be in regards to comfort measures in the ER.

[canoehead]

If it will take more sticks to numb the area than it will to close the wound we don't use lidocaine either.

[magicman]

Originally Posted by UMTXRN

First question, Don't physicians normally use lidocaine before applying sutures and or staples?

After working 20+ years in emergency medicine, I can tell you that MOST docs won't use lido at all for staples. The decisoin to use staples is beacaue of the place of the lac to begin with. There is normally minimal pain comparatively with lidocaine when using them and the size of the lac is usually small. Staples are maily a time saver in compairison to sutures also.

Originally Posted by UMTXRN

Second, Advice please. This is a tiny hospital, if I had issues with this guy, what is the BEST way to go about getting things changed without everyone knowing I was the one reporting it. Has anyone else been through a similar situation?

If you have questions about what a physician is doing and why, unless he's a real tight ***, then ask him. I've found most E.R. docs are more than happy to help you learn when asked in the right way. They actually find it refreshing that someone wants to learn more and even start to find you for things to teach!! (This is especially true in smaller E.D.'s since the physician and nursing staff work so closely together) The other person to talk to if you have a problem is your nurse manager. He/she should be a resource to you for any questions (especially, again, with a smaller E.D.).

Good luck and welcome to the wonderful world of the E.D. (better known as the jungle/knife and gun club/hell/where insanity meets reality/etc.! Hahahahaha)

[caroladybelle]

Could they have them speak to the OP surgery area?

I am so tired of people sticking me with lidocaine before starting an IV.

It's another stick, just start the IV without it for goodness sakes.

[Spidey's mom]

Originally Posted by caroladybelle

Could they have them speak to the OP surgery area?

I am so tired of people sticking me with lidocaine before starting an IV.

It's another stick, just start the IV without it for goodness sakes.

That is so interesting because I get chastized all the time about not using lido before starting iv's . . .unless the patient wants it and they usually don't.

steph

[UMTXRN]

Thanks so much for all your advice and responses. That clears things up for me. I just felt so sorry for the boy who was getting the staples. It's good to know this is a common practice. AND I was not aware that lidocaine was so painful. BTW, we do not give it before starting IV's either.

Anyway, thanks again for the tips.

[teeituptom]

Mix a little bicarb in the Lido and it soesnt sting anywhere near as much

[NCgirl]

Just ask the preop people to do without the lido...you are the patient afterall, and have more rights at that moment than any other time. And I don't know what kind of IV's your having, but as an anesthesia student, we start 18's almost all the time for surgery. Would you really rather an 18 over a stick for some lido? I'm just curious, seriously not be a smartbutt.