Rust Ring Removal

[thegenius]

Is removing a rust ring with a burr device a core EM competency? I've never learned how to do it. I know it's not an emergency and Ophtho can remove urgently. trying to decide whether I should even indicate this on my privileges form for my hospital.

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[xaelia]

Not a core requirement of emergency medicine.

 

[Groove]

Is removing a rust ring with a burr device a core EM competency? I've never learned how to do it. I know it's not an emergency and Ophtho can remove urgently. trying to decide whether I should even indicate this on my privileges form for my hospital.

I seem to remember doing it in residency but I’ve never done it since.

 

[eyeeye_captain]

Nope. I did them in ophtho residency and I think only one was with a burr. A needle is usually enough for a decent debridement anyway. As long as the foreign body is out and they’re on antibiotic drops, you’ve done plenty.

 

[ERMudPhud]

Its easy to do but how many even have a burr in their ED? In my experience almost none do

 

[AlmostAnMD]

So after an optho friend of mine told me that actually puncturing the sclera would be like pushing a needle through cardboard and we are all just afraid of eyes for no reason, I started using the burr exclusively for eye stuff/FB/rust rings. 100% success, super ****ing easy, definitely something not worth being afraid of. Actually somewhat satisfying. Shave that ****er off and move on

 

[xaelia]

100% success, super ****ing easy, definitely something not worth being afraid of.

What about for Dr. Edward Tremorhands over here.

 

[thegenius]

So after an optho friend of mine told me that actually puncturing the sclera would be like pushing a needle through cardboard and we are all just afraid of eyes for no reason, I started using the burr exclusively for eye stuff/FB/rust rings. 100% success, super ****ing easy, definitely something not worth being afraid of. Actually somewhat satisfying. Shave that ****er off and move on

It was asked on my delineation of privileges for my hospital and I've literally never done one. I'm not sure if our ER even has one. So what's the point of saying I'm competent to do it when I've never done it. Can have a fully functioning ER (and board certified Er docs) without a burr, I reckon.

 

[TooMuchResearch]

Its easy to do but how many even have a burr in their ED? In my experience almost none do

All of our EDs do but also 75% of our doctors were trained at programs that considered this very much in the ED realm of care.

 

[Mount Asclepius]

Eye foreign bodies and rust rings are rare.

We remove foreign bodies and occasionally remove rust rings. This is likely due to difficulty with close ophthalmologic follow-up as well as comfort level with prior training. I agree that many are often overly scared of eyeballs. It’s understandable. No one wants to pop a balloon. Especially when that balloon is really important. You won’t though.

However, I don’t think removing rust rings is emergent or required.

Regarding privileges. You shouldn’t maintain privileges for procedures you aren’t willing to do as you can get into rare sticky situations if you don’t perform procedures that you are privileged to do. This is rare, and further more uncommon that you would get hung out to dry for.

That being said, sometimes it is best for the patient that you buck up and do the procedure even if rare or ill-trained because the delayed or unavailable alternative is worse. I haven’t checked a compartment pressure, performed a pericardiocentesis, or scrambled through a resuscitative hysterotomy any time recently or ever for some of those. I might be in the situation where I’m that answer to a patient though. I wouldn’t shy away. Not saying I’d be thrilled, but that’s also what I signed up for. I’m there when it matters. It would also potentially give me career satisfaction.

You might be surprisingly satisfied when you burr out a metal shaving and the remaining rust ring for a welder, blue collar worker in the evening who is just trying to support his family and doesn’t know how to or can’t afford to see private practice optho during business hours.

 

[xaelia]

Eye foreign bodies and rust rings are rare.

Oh jeez, we get multiple at day into our fast track. Usually tiny metal shards from inadequate eye protection.

Usually not much of a ring to bother with; they tend to come in quickly, and some of the metal is non-oxidizing.

 

[BoardingDoc]

It was asked on my delineation of privileges for my hospital and I've literally never done one. I'm not sure if our ER even has one. So what's the point of saying I'm competent to do it when I've never done it. Can have a fully functioning ER (and board certified Er docs) without a burr, I reckon.

You should not check the boxes next to any skill that you don't have when doing credentials. As mentioned elsewhere, it serves no purpose and can only get you into trouble in rare cases. If everything is prechecked, I just draw a line through the relevant items and date+initial next to it.

 

[AlmostAnMD]

You should not check the boxes next to any skill that you don't have when doing credentials. As mentioned elsewhere, it serves no purpose and can only get you into trouble in rare cases. If everything is prechecked, I just draw a line through the relevant items and date+initial next to it.

Rofl

I'd cross out pelvic exams if I could have line item vetoed

"AlmostAnMD, 5/28/25, religious reasons" next to it