You are a 4th year EM resident moonlighting on your first day in a remote area as the solo provider that has minimal availability to consulting services. The nearest major hospital is approximately 100 miles away.
A 5 year old child enters your ED at 3 am with a large, complex laceration to the face from a dog bite which will likely require sedation and a layered closure. His injuries were sustained approximately 6 hours ago. The wound is complex and will require a multi-layered closure and there are a couple of areas of tissue avulsion. You have 1 or 2 cases of similar experience from approximately 1 year ago on your plastics rotation...
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