Hi everyone!
So today I’m going to do something a little different.
As many of you know, I am currently doing my away rotations as a 4th year medical student.
This month, as part of my away rotation project, I’ll be making a video to contribute to
the FOAM education community.
If you’ve never heard of FOAM, it stands for FREE OPEN ACCESS MEDUCATION (OR MEDICAL
EDUCATION).
It is basically a collection of FREE medical education resources that can be accessed online
by students and healthcare professionals.
It exists in several different forms including but not limited to podcasts, blog entries,
online videos, and so much more.
So in my efforts to contribute to this awesome growing online movement, I will be making
a video about ring removal in the emergency department.
So I’m going to talk about 3 different techniques on removing a ring that is stuck on a finger.
As a disclaimer, these are techniques that should be used in the emergency room and not
meant to replace a visit to the emergency room or an evaluation from a doctor
As a general rule of thumb, every time you have an injury or a bug bite on your finger,
you should remove all rings as soon as possible to prevent your rings from getting stuck on
a swollen finger.
The first step is examining the finger for underlying skin damage and any signs of vascular
compromise including mottling, absent capillary refill, or gray color.
In cases of vascular compromise, the ring should be removed as soon as possible.
Next, administer proper analgesia.
You can achieve this by doing a digital block with lidocaine- or if the patient is too young
or uncooperative, you can consider sedation as well.
There has been suggestion of using epinephrine-free local anesthetics because ischemia may be
worsened with vasoconstrictive effect of epinephrine.
Step 3, clean the surrounding skin with antiseptic solution and determine if the patient needs
tetanus vaccine depending on the wound.
Step 4, apply ice or elevate the extremity to reduce swelling as much as possible.
After step 4, there are a variety of techniques to actually remove the ring.
First one I’ll discuss is using a ring cutter.
IF there is any sign of ischemia as discussed before, the fastest way to get the ring off
would be cut it.
Some trauma shears have a designated ring cutter built in.
The hardest part here would be to insert one end of the ring cutter under the already tight
space.
There is also an electrical ring cutter that many emergency departments carry.
If you are using this, you have to make sure to protect the skin underneath by placing
a thin metal object such as a malleable retractor between the ring and the finger.
Some ring cutter may have its own protective metal guard you can use.
You want to place the thinnest part of the ring towards the palm of the hand and use
the electrical ring cutter with the palm facing up.
You may want to avoid using the electrical ring cutter in cases with lacerations because
the metal filing from the ring can cause a foreign body reaction in the wound.
You should proceed slowly, constantly wet the finger, and take breaks because the friction
of the electrical ring cutter will heat up the metal and can cause skin damage and discomfort.
You may also want to consider eye protection for the patient and yourself.
Next up is the string wrap technique.
Again, you want to avoid this technique if the patient has a laceration or a fracture
distal to the ring.
You can either use a 2.0 or 3.0 suture or I’ve seen the elastic string of a nonrebreather
being used as well.
To perform this technique, place one of the of suture or string under the ring and tightly
wrap the string around the finger.
As a reminder, this isn’t the most comfortable procedure so make sure your patient is properly
anesthetized.
Continue wrapping the material until the end of the digit and make sure there is no tissue
visible between the strings.
When you’re done wrapping, start pulling on the proximal end of the string in a circular
manner until the ring is removed.
The idea here is to wrap the finger tight enough to bring down the swelling so the ring
can come off.
Lastly, the surgical glove technique.
You can use this technique even if there is an open wound of the digit.
To perform this technique, cut one finger of the sterile glove off to form a thin sleeve.
Place one end of the sleeve under the ring using a hemostat or another tool.
Fold over one end of the sleeve over and pull off the ring in a twisting motion.
Those are all the techniques I have for removing a ring.
After removal, always clean the finger thoroughly and use an antibiotic ointment if there is
any concern for open or possible infected wounds.
Make sure the circulation returns distal to where the ring was stuck and consult a hand
surgeon if there is any doubt or concerns.
That’s all I got for today- Let me know if you guys found this video to be interesting
or helpful!
I will link all the references in the comment box below.
Please share if you have a favorite FOAM resource
And I will see you guys in the next video. Byee!