Over the past week, we’ve had a strange uptick in number of patients presenting to the ER with rings stuck on their finger. This is a quick review on the options that you have regarding how to remove them. Assuming your patient has tried soaking their hand, and tried soap to remove it, there are a few options on what you can do next.
Option #1: The Cutter
This is your bread and butter approach; the ring cutter. Here in the Sinai ED, the ring cutter is kept in the Resus medicine room, locked in the hazmat cabinet. A nurse can remove the hazmat key from the Pyxis (just make sure you give it back!). The use of the ring cutter is self explanatory; slide the prongs under the finger, and either hand crank or use the mechanical drill. Another option is the Leatherman Raptors, a multi-tool that has built in ring-cutters. Benefits: Fast and painless. Drawback: the ring will be destroyed, may or may not be reparable.
Option #2: The Magic Trick
This wizardry is a well appreciated method that allows you to remove the patient’s ring without causing any damage to their jewelry. It involves wrapping the finger (distal to proximal) with some string or floss, passing it under the finger, and slowly sliding the ring off. The wrapping needs to be done tightly, to reduce the edema of the finger. In the emergency room, the elastic strap from a nonrebreather mask works well.
It is a more time consuming manner of removing a ring; I find it a worthwhile try if the patient tells you their ring holds significant sentimental value. It should be your go-to method if you find the patient’s ring is made of a material that cannot be cut. Please see the bottom of this post for an excellent ALiEM video demonstrating this technique.
Important to note: Rings of different alloys may not be able to be cut with conventional methods. Titanium is notoriously difficult to cut, and it may even be necessary to get FDNY involved (or if possible, try hospital bolt cutters!). Tungsten and ceramic shatter into pieces, and can cause secondary injuries. Gold is very malleable, and is easier to cut.