Ver el código de «Ring removal»

==Overview==
[[File:Transgender with shaved pubic hair – removal of the frenulum (ribbon on the foreskin) – and concealed worn, inner penis ring made of platinum - Picture 001.jpg|thumb|Entrapped penile ring.]]
*Rings can pose a significant threat to body parts after an injury. When body parts with rings begin to swell, the ring acts as a tourniquet and prevents blood and lymph from returning to circulation. 
*With severe swelling, the restriction of the ring can lead to necrosis and amputation of the affected tissues. 
*Typically on fingers, but may occasionally be on other body parts (e.g., penile ring)

==Indications==
*Should be preemptively removed in the ED for patients with any significant limb injury, infection, or need for [[IVF]]
*Other indications for ring removal include:
** Swelling
** Cyanosis
** Need for proximate evaluation
** Numbness or pain
** Difficulty removing the ring
** Required imaging where the ring will cause interference (MRI, etc.)

==Contraindications==
*No absolute contraindications

==Equipment Needed==
*Dependent on technique (see below)

==Procedure==
[[File:Removal of ring from digit.jpg|thumb|Image showing string removal setup (Procedure 1). Note that the string loops should optimally be closer together and start closer to the ring itself.]]
[[File:Finger ring cutter.jpg|thumb|Image showing manual ring cutter with guard correctly placed between the ring and the skin.]]

===== Lubrication Removal =====
''Typically the first attempt, unless already attempted by patient''
*Suitable lubricants: mild soap and water, lubricating jelly (e.g., K-Y jelly), safe oils
*Apply between ring and underlying skin
*Once lubricated, attempt to remove the ring

===== String Removal =====
*Consider pre-lubrication (see above)
*Possible equipment to use: large diameter nylon suture (with needle cut off), other thin string, venous tourniquet 
*Described Procedure 1:
**Insert string under ring with majority of string left on distal side of ring
***Wrap the string around the finger ensuring little-to-no space between each time around (should provide maximal constriction of the finger without causing injury)
***Using the proximate end of the sting (proximate to the ring), slowly unwrap the sting
****This should provide a cork-screw-type mechanism that moves the ring distally while compressing the tissues underneath
*Described Procedure 2:
**Place one or more strings underneath the ring
***Use as traction to pull and remove ring from body-part

===== Ring Cutter Removal =====
*Use a manual or electric ring cutter
**If using an electric ring cutter, stop frequently to check for heat buildup to prevent burns
*Warn patient this is a destructive procedure for the ring
*Place the guard between the ring and the skin
**Normally supplied with and frequently connected to the cutting device
*Use the circular blade to cut, ensuring the guard is in place and will prevent tissue injury if/when the device fully cuts through the ring
*Make one or two (if ring is hard to bend) cuts, as necessary
**May consider using plyers or similar to bend ring after one cut, if helpful
*Remove ring

===== Last Resort Measures =====
''Heightened risk for injury to underlying tissues
*This is for rarer cases, where the ring cutter blade is not sufficient to cut through the ring material 
**For example, high-strength materials such as tungsten and titanium rings
*Consider other resources (e.g., from fire EMS or facilities management, depending on local protocols)
**For example, hydraulic cutting tools or more power (e.g., Dremel with diamond crusted blade)
*May need to fashion makeshift guard for between ring and body-part
*If using an automatic rotating blade, stop frequently to check for heat buildup to prevent burns

== Complications ==
* [[Laceration]] and abrasion of underlying tissues
* [[Joint dislocations]]
* Nerve and vascular damage
* Accidental [[amputation]]

==See Also==
*[[Hand and finger diagnoses]]

==External Links==


== References ==
<references/>
*Reichman, Eric F. Emergency Medicine Procedures. McGraw-Hill, 2013.

[[Category:Procedures]]