Children with lacerations that require suturing are typically afraid and uncooperative. The pain of a local lidocaine injection will increase their fear and lack of cooperation. For nonfacial lacerations, I find that spraying the area with ethyl chloride just before injecting the lidocaine reduces the pain and thus eases fears. Suturing is then much easier.It can sometimes be difficult to detect the fine tremors of the hands and fingers of a patient with hyper-thyroidism. For help in picking these up, place a sheet of paper on the patient's outstretched hands and fingers; the vibrating paper will reveal the tremor.
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