ujuzi: ring removal: a critical emergency procedure

African Journal of Emergency Medicine (2012) 2, 127–128

African Federation for Emergency Medicine

African Journal of Emergency Medicine

www.afjem.comwww.sciencedirect.com

Ujuzi: Ring removal: A critical emergency procedure

(Practical Pearl/Perle Pratique)

Amit Chandraa,*, Tendai Muchedzi

b

a Department of Emergency Medicine, University of Botswana School of Medicine, Gaborone, Botswanab Accident & Emergency Department, Princess Marina Hospital, Gaborone, Botswana

Received 28 January 2012; accepted 23 April 2012

Available online 15 May 2012

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KEYWORDS

Ring removal;

Ring tourniquet syndrome

Corresponding author.

-mail address: amit.chandra

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ª 2012 African Federation for Emergency Medicine. Production and hosting by Elsevier B.V. All rights

reserved.

Ujuzi means skills in Swahili and is intended to be a regular

feature for colleagues to share practical interventions, innova-tions and novelties that have proved useful in the managementof patients in the prehospital environment or Emergency Cen-

tre. You can let Ujuzi know about your practical ideas byemailing practicalpearl@afjem.com.

Case scenario

A 35-year-old male with an unspecified psychiatric history isreferred to your Emergency Centre from a local clinic. He ap-

pears intoxicated and complains of a painful left 4th digit. Onexamination, you note a steel ring on a grossly oedematous left4th digit. You obtain your department’s ring cutter, and find

that its blade is too dull to penetrate the steel. You apply lubri-

.ub.bw (A. Chandra).

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. All rights reserved.

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cating jelly to his finger and attempt to remove the ring by

force. As you struggle, your patient becomes combative.

Introduction

Ring removal presents a challenging clinical dilemma in re-source limited emergency departments. Rings should be ideallybe removed prior to finger swelling in all patients admitted to

an intensive care unit and in patients with high risk pathology,

Fig. 1 Sutures placed on opposing sides of ring.

Fig. 2 Traction applied to sutures to remove the ring.

128 A. Chandra, T. Muchedzi

e.g. burns and blunt trauma. If swelling has already occurred,the ring exerts a tourniquet effect and threatens digit ischemia.

Techniques of ring removal

Multiple techniques of ring removal have been described in the

literature. The widest point of the finger is usually the proximal

interphalangeal joint (PIP), so once the ring is advanced be-yond that point it can usually be removed. A common tech-nique often involves cutting the ring with a commercial ring

cutting device or a dental drill. Finger swelling can be reducedwith ice, a compression bandage, or by wrapping suture threadaround the digit. The finger can also be lubricated with a

water-based lubricant.

Applying traction with suture

Using multiple techniques simultaneously (compression, lubri-cation, traction) often increases the chances of success when aring cannot be cut with a commercial or dental device. Trac-

tion on the ring can be optimized by looping two pieces of su-ture thread (e.g. 0-Silk) at opposing sides of the ring andapplying force (see Figs. 1 and 2).1

Reference

1. Burbridge MT, Ritter SE. An alternative method to remove a ring

from an edematous finger. Am J Emerg Med 2009;27(9):1165–6.