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Scenario 1
Knee laceration is not a life threatening injury. Consent from the parents is necessary.
Give 2 options
1) Suturing will be done under adequate sedation Eg: Ketamine,
along with an anesthetist or another emergency physician. Follow the same procedure as day care surgery.

2) Suturing to be done under local anesthesia and an analgesic plus mild sedative Eg: Morphine plus or minus midazolam. Use this option if the parents are poor and cannot afford option 1.
Obviously the child will be distressed but the parents can be prepared well by adequate explanation of the procedure and counselling.
And i think you can take the 5 stitches in about 6-7 minutes.



Scenario 2
This is a little difficult situation. You need more input from others. But here is what I think. 16 year old is a minor. Consent is required from a parent or a guardian before undertaking the surgery.

If I had seen this patient, I would have throughly counselled the girl along with another lady doctor or social worker and convinced her to let me inform her parents. (I will do this even if it takes me a couple of hours - Provided the patient is stable)
Then I will counsel the parents before they meet the girl, to ensure they will be 100% supportive. Then take their consent for surgery and go ahead.

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A teenage girl will be highly disturbed in such situations and this is an ideal time for suicidal thoughts. It is of utmost importance to select the most senior & experienced person to proceed carefully with the counselling. Full trust of the patient MUST be achieved.
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