# Till death do us part



## wilderness911 (Feb 8, 2016)

Here's a scenario that is more arts and crafts than medical knowledge. Your patient is a 67 year old man with a hx of right wrist fracture 24 hours earlier. After it was set and casted at the ED, he returned home and went to sleep but woke up to find that his left finger had become severely swollen below his wedding ring. His wife died three months earlier and he is more concerned about the ring than he is about his finger (which, although obviously edematous and purple, still exhibits decent capillary refill). The ring is not going anywhere without a little creativity. How are you going to help this patient preserve both ring and finger, sparing him a trip to the ER or a visit from fire with a cutting tool? 

There may be more than one right answer on this. I have a particular method of macgyvered solution in mind but am curious to see what others come up with.


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## OnceAnEMT (Feb 8, 2016)

When I do rings, my first goal is to pull it distally and get it as close to the PIP joint as I can without actually being on the joint. Do this via dry/as-is, lube, and/or milking the swelling (if present). Then, flex the PIP 90 degrees, pulling distally again to snug the anterior aspect of the ring against the middle phalanx. From here, you should be able to swivel the posterior aspect over the PIP until the whole ring is only on the middle phalanx. From here it should be smooth sailing. This is easier for bands, more difficult for smaller-width rings. I've had to spend a couple minutes focused on a ring, but I haven't been stumped yet with this method. Just need to be patient, and hope the patient is a little tolerant to the pulling...


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## Underoath87 (Feb 8, 2016)

You just wrap dental floss tightly around the distal portion of the finger.  The floss constricts the swollen tissue and allows the ring to slide off more easily.


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## DesertMedic66 (Feb 8, 2016)

Cut the finger off. 

The elastic cord of a non-rebreather works great. Wrap it tightly on the finger and pull the free side thru the ring. Pull on the cord and as the cord slowly unwinds it will take the ring with it. You may need some lube so the lube we carry for NPAs works pretty well. Had to do it twice during my medic internship.


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## wilderness911 (Feb 8, 2016)

DesertMedic66 said:


> Cut the finger off.
> 
> The elastic cord of a non-rebreather works great. Wrap it tightly on the finger and pull the free side thru the ring. Pull on the cord and as the cord slowly unwinds it will take the ring with it. You may need some lube so the lube we carry for NPAs works pretty well. Had to do it twice during my medic internship.



Bingo! That's my preferred way of dealing with it. Not only works great but looks badass as well. Great video tutorial of it here:


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## wilderness911 (Feb 8, 2016)

Underoath87 said:


> You just wrap dental floss tightly around the distal portion of the finger.  The floss constricts the swollen tissue and allows the ring to slide off more easily.



While I think this would work, it would probably hurt like hell to have your finger wrapped up in dental floss because it's so fine. I've heard of the dental floss method as well; but personally prefer the NRB strap. Just speculation though. If you do use the floss, be sure to push it through and then let the string remove the ring for you in the spiral motion shown in the video. Good stuff


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## NomadicMedic (Feb 8, 2016)

Yeah. I learned the trick with the green elastic from an NRB. Never used it, but certainly seems less traumatic to the patient than fire using hydraulic rescue tools.


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## chaz90 (Feb 8, 2016)

This is outstanding. I've not had to remove a stuck ring, but I imagine this results in much happier patients than the more destructive methods.


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## Underoath87 (Feb 8, 2016)

wilderness911 said:


> While I think this would work, it would probably hurt like hell to have your finger wrapped up in dental floss because it's so fine.



I don't imagine it would hurt if you used the ribbon type and wrapped it up completely so that no skin shows.  This would also give you a nice, uniform Teflon surface, vs the lightly ribbed NRB stuff.


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## Summit (Feb 8, 2016)

DesertMedic66 said:


> The elastic cord of a non-rebreather works great. Wrap it tightly on the finger and pull the free side thru the ring. Pull on the cord and as the cord slowly unwinds it will take the ring with it. You may need some lube so the lube we carry for NPAs works pretty well. Had to do it twice during my medic internship.


I have used this technique before with good results.


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## MonkeyArrow (Feb 8, 2016)

DesertMedic66 said:


> Cut the finger off.
> 
> The elastic cord of a non-rebreather works great. Wrap it tightly on the finger and pull the free side thru the ring. Pull on the cord and as the cord slowly unwinds it will take the ring with it. You may need some lube so the lube we carry for NPAs works pretty well. Had to do it twice during my medic internship.


+1. But be aware, sometimes, the ring just won't come off and you will need to cut it. Learn when to cut your losses (and advise your patient to do the same) and move on. [No pun intended].


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## johnrsemt (Mar 14, 2016)

and if the ring has to be cut off most jewelry stores will repair if fairly inexpensively


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## ViolynEMT (Mar 14, 2016)

wilderness911 said:


> Bingo! That's my preferred way of dealing with it. Not only works great but looks badass as well. Great video tutorial of it here:



This is what I was going to say. I remember seeing this a few months ago.


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