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Are you guys stealing people's fingers? Please reply soon, thanks.

Why is everyone so paranoid about getting their finger chopped off anyway? Are the ER people kleptomaniacs? Should I be worried?
 
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Apollyon

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You put a lot of effort into generating this post, but I'm not sure why. After a ring is cut off, it's not wearable again, and the patient gets it back. Hopefully, the finger itself is still attached and functioning (which it usually is).
 

Rabbit Hole

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The inquiry originated from this thread in the surgery forum but went unanswered because they're surgeons. I was trying to have a laugh, but all I got was a sterile OR response - cold and uninviting. Just kidding, they're a fabulous bunch.

Anyway, what I was trying to get at..
What is the reason behind cutting off the rings? Prevent edema I suppose? How often do you have to literally cut jewelery off of patients and do they get pissed off about this?
 

Apollyon

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The inquiry originated from this thread in the surgery forum but went unanswered because they're surgeons. I was trying to have a laugh, but all I got was a sterile OR response - cold and uninviting. Just kidding, they're a fabulous bunch.

Anyway, what I was trying to get at..
What is the reason behind cutting off the rings? Prevent edema I suppose? How often do you have to literally cut jewelery off of patients and do they get pissed off about this?
Edema to the fingers is common, often after trauma. I never had to do it once as a resident, but a few times as an attending on the east coast. If you've ever taken a look at fat fingers, the rings are already on there tightly, so it wouldn't take much to compromise circulation.

When a finger is purple, painful, and swollen, people will do anything to get them off. They're not pissed about this; they want the pain gone. Even if a patient was to complain, you offer them the alternative - "Would you rather I left the ring on, and your finger died off, became necrotic, then gangrenous, smelled like a dumpster, then fell off?"
 

Tiger26

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Edema to the fingers is common, often after trauma. I never had to do it once as a resident, but a few times as an attending on the east coast. If you've ever taken a look at fat fingers, the rings are already on there tightly, so it wouldn't take much to compromise circulation.

When a finger is purple, painful, and swollen, people will do anything to get them off. They're not pissed about this; they want the pain gone. Even if a patient was to complain, you offer them the alternative - "Would you rather I left the ring on, and your finger died off, became necrotic, then gangrenous, smelled like a dumpster, then fell off?"
Thus triggering another possible cause of their sepsis, in addition to the usual UTI, fungal in the folds, filthy permacath, chronic pneumonia, needle-marked epidermis, uncared-for colostomy bag . . .
 

Apollyon

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Had a guy come into the ED last week with his sister, and the sister wanted a second opinion as to whether the finger needed to be amputated (I think the guy might have been a bit LD). Actually, the closure/reattachment was done by ortho, and it was a pretty good job - you could see where the finger was mangled, and how ortho had put it together. First time I've ever seen staples in a finger! The patient said that "the middle was all black, but then it looked like a regular finger again!"

I told the sister that I wasn't a surgeon, so it wasn't my call as to whether the finger stayed on or not, but that I thought the distal phalanx (which was black, shiny, and intact) was going to have to come off. I told him that, if it wasn't removed, it would start to rot and smell like a dumpster (I say that a lot, because that's what it smelled like when I was a 3rd year med student in NYC - just like the Brooklyn dumpsters outside, this patient's toe smelled like it inside). He then put the finger to his nose and inhaled deeply, but did not report a stench.
 
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Do EDs carry the tools necessary to remove a tungsten ring? Ive heard they can only be crushed not cut....
 

Rabbit Hole

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Had a guy come into the ED last week with his sister, and the sister wanted a second opinion as to whether the finger needed to be amputated (I think the guy might have been a bit LD). Actually, the closure/reattachment was done by ortho, and it was a pretty good job - you could see where the finger was mangled, and how ortho had put it together. First time I've ever seen staples in a finger! The patient said that "the middle was all black, but then it looked like a regular finger again!"

I told the sister that I wasn't a surgeon, so it wasn't my call as to whether the finger stayed on or not, but that I thought the distal phalanx (which was black, shiny, and intact) was going to have to come off. I told him that, if it wasn't removed, it would start to rot and smell like a dumpster (I say that a lot, because that's what it smelled like when I was a 3rd year med student in NYC - just like the Brooklyn dumpsters outside, this patient's toe smelled like it inside). He then put the finger to his nose and inhaled deeply, but did not report a stench.
Well.. it's a good thing he didn't report that it smells like home!
Thanks for the good explanation and noting how often you see this scenario.
 

Arcan57

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We had to remove one of those rings when we went to cath a demented 89 yo man. His daughters said they took him to the hardware store because he said he needed to get a ring to fix his flashlight. They were... non-plussed about the situation. FWIW, I like the dental floss wrapping method for getting off rings.


Just read back the above paragraph, I don't think he intended the "fixing his flashlight" as a double entendre.
 

Dr.McNinja

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Less dental floss, more umbelical tape.
Strangely, I haven't cut one ring off in residency. I did it monthly back in college (not on myself mind you). Maybe the people out here are just too poor to afford rings or something.
 

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Do EDs carry the tools necessary to remove a tungsten ring? Ive heard they can only be crushed not cut....
I just carry around Chuck Norris in my back pocket. Chuck is so tough, one look and the tungsten disintegrates...
 

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"Dental floss wrapping method"? Use floss to compress the tissues to get the ring off? Start distally and work toward ring??
 

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We had a stainless steel ring that wasn't placed on a finger (I'll leave that one to the imagination). Patient had to go to the OR and had to use this device to get it taken off: http://www.anspach.com/black-max.html
I removed a metal ring on a guy's junk once. It was pretty difficult to do, since the glans was swollen to the size of an apple and the ring had been in place for 4 days. The thing was seriously a tad thicker than the metal on my Master Cardio stethoscope and took a half hour cutting through the metal with a ring cutter (the electric cutter wasn't strong enough). Even after a half hour, the metal was only half way through, so I got a set of 2 foot long bolt cutters from housekeeping, stuck a tongue depressor in between the ring and the skin, closed my eyes and cut the ring. The was just one of the 2 cuts it took. In total, I spent an hour and a half cutting that thing off.

Oh, and necrotic hands/digits are disgusting. One lady I saw on medicine fell asleep in the snow, and her whole hand basically died, but surgery decided against removing it for some reason. It's hard to describe exactly how her hand looked. The best description I could use is that eventually it was like a dried out corpse from your anatomy lab at the end of the year that wasn't well cared for...completely atrophied to the bones, black/brown, brittle, immobile, and hard as a rock. In all seriousness, it looked like it was straight out of a horror movie. Maybe I'm sick and twisted but I really wanted to get a picture of it so I could show it to my kids some day and then tell them that's why they ought to listen to me when I tell them to bundle up and wear their coats in the winter.
 
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Holy crap, I thought my friend's dad cutting a ring off my finger with a bolt cutter was bad.
 

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Hmmph, how disappointing. When I clicked on this link I was hoping there was some twisted resident who was literally stealing fingers from his ED and was caught and reprimanded. Fetish stories are so much more interesting than "serious cat" questions. Even light-hearted ones...
 

Rabbit Hole

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We had to remove one of those rings when we went to cath a demented 89 yo man. His daughters said they took him to the hardware store because he said he needed to get a ring to fix his flashlight. They were... non-plussed about the situation. FWIW, I like the dental floss wrapping method for getting off rings.
I removed a metal ring on a guy's junk once. It was pretty difficult to do, since the glans was swollen to the size of an apple and the ring had been in place for 4 days. The thing was seriously a tad thicker than the metal on my Master Cardio stethoscope and took a half hour cutting through the metal with a ring cutter (the electric cutter wasn't strong enough). Even after a half hour, the metal was only half way through, so I got a set of 2 foot long bolt cutters from housekeeping, stuck a tongue depressor in between the ring and the skin, closed my eyes and cut the ring. The was just one of the 2 cuts it took. In total, I spent an hour and a half cutting that thing off.
Hmmph, how disappointing. When I clicked on this link I was hoping there was some twisted resident who was literally stealing fingers from his ED and was caught and reprimanded. Fetish stories are so much more interesting than "serious cat" questions. Even light-hearted ones...
Yea, I was just trying to have a good laugh with this thread by implying that ED residents have a propensity to steal fingers, I didn't expect for all this hilarity to ensue!

Speaking of "fetish stories", how in the hell did those guys get rings on their "flashlights" in the first place? I mean, come on.. what were they doing? I know some male psychiatric patients do some weird things like inserting objects (pens, wires) up their urethra. I also know that some prison patients intentionally harm themselves so they can get a "hospital vacation".

"Hey doc, believe me when I say I slipped in the shower and fell on this shampoo bottle. I can't get it out of my rectum." What other sort of things have you encountered that fall under the questionable category? Oh, and ER residents stealing fingers is still fair game.
 

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I removed a metal ring on a guy's junk once. It was pretty difficult to do, since the glans was swollen to the size of an apple and the ring had been in place for 4 days. The thing was seriously a tad thicker than the metal on my Master Cardio stethoscope and took a half hour cutting through the metal with a ring cutter (the electric cutter wasn't strong enough). Even after a half hour, the metal was only half way through, so I got a set of 2 foot long bolt cutters from housekeeping, stuck a tongue depressor in between the ring and the skin, closed my eyes and cut the ring. The was just one of the 2 cuts it took. In total, I spent an hour and a half cutting that thing off.
Precisely how does one bill for that?:confused:
 

NEATOMD

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Precisely how does one bill for that?:confused:
I documented the time spent as critical care time. I'm not sure if that's how it ended up getting billed out...but if it was me in that dude's position I definitely would have considered it CRITICAL care.
 

NEATOMD

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Holy crap, I thought my friend's dad cutting a ring off my finger with a bolt cutter was bad.
The scene was even better in real life than you could imagine because I'm a pretty small guy (read: almost no muscles) and have a pretty dominate familial tremor. So, you should have seen those cutter's shaking while I was trying to cut through that ring. Seriously, if he wasn't so desperate to get that ring off there's no way he would have let me come near him with those cutters.
 

dmitrinyr

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The scene was even better in real life than you could imagine because I'm a pretty small guy (read: almost no muscles) and have a pretty dominate familial tremor. So, you should have seen those cutter's shaking while I was trying to cut through that ring. Seriously, if he wasn't so desperate to get that ring off there's no way he would have let me come near him with those cutters.
:D:D
If I was him and saw you coming at me with huge metal cutters and shaking away with your tremor, I'd seriously consider grabbing those cutters out of your muscle-less arms and cut the damn ring off myself.