This is a guide on the approach to procedures in the emergency department. The focus includes attention to pain and comfort measures and evidence-based techniques to optimize success. Tongue lacerations do not always need to be repaired, but when they are large or gaping, certain measures should be taken to ensure success. Several techniques for the reduction of emergent paraphimosis and removal of hair tourniquets are described. Loop drains are easy to place and have numerous advantages over traditional incision and drainage. Finally, a new ultrasound approach may be helpful in identifying landmarks prior to performing a neonatal lumbar puncture.