Acute Medicine & Surgery最新文献

{"title":"Seizure occurrences among hypoglycemic patients in the emergency department","authors":"Seigo Urushidani,&nbsp;Mao Tanabe,&nbsp;Kwangsoo Baek,&nbsp;Koki Miyaguchi,&nbsp;Tetsunori Ikegami","doi":"10.1002/ams2.979","DOIUrl":"10.1002/ams2.979","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Symptomatic hypoglycemia is a common problem in the emergency department (ED). However, without appropriate recognition and management, hypoglycemia remains a potentially fatal condition. The cause of sudden death associated with hypoglycemia might be attributed to cardiac arrhythmias and hypoxia with seizures. Despite advances in diabetes mellitus management and social background, the frequency and characteristics of patients with hypoglycemia-related seizures have remained unknown. Hence, our study aimed to investigate the frequency and characteristics of patients with hypoglycemia presenting with seizures in the ED.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study was conducted in a single tertiary care center. Patient information was retrieved from the final diagnostic records in the ED. We reviewed all medical records and included patients with symptomatic hypoglycemia aged 16 years or older. The primary outcome was the frequency of seizures in patients with hypoglycemia. We also compared the initial blood sugar levels of the patients with and without seizures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included a total of 380 patients (median age, 72 years, IQR 64–80 years; median initial blood sugar, 34 mg/dL, IQR 24–46; 62.9% male). Nineteen of 380 patients (5.0%) had seizures. Although 16 of the 19 patients had diabetes mellitus, none of the 19 patients had a history of epilepsy. The initial blood sugar levels of the patients with and without seizures were not significantly different (<i>p</i> = 0.97).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Approximately 5% of the patients with hypoglycemia presented with seizures. Blood glucose levels of hypoglycemic patients with and without seizures did not differ.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11223063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141533279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The timing of death in burn patients","authors":"Kazuhiro Yoneda,&nbsp;Akinori Osuka,&nbsp;Shinya Ohnishi,&nbsp;Hiroshi Matsuura,&nbsp;Jun Oda","doi":"10.1002/ams2.970","DOIUrl":"10.1002/ams2.970","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>When treating burn patients, some patients die in the chronic phase, even if they overcome the acute phase of the burn. To elucidate the timing of death and its underlying causes among burn patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients evaluated were admitted to our burn center between January 2015, and December 2019. Patient information, time, and cause of death were retrospectively collected from their medical records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 342 admitted patients, 49 died. The time of death was as follows: within 24 h (<i>n</i> = 9), within 3 days (<i>n</i> = 7), within 1 week (<i>n</i> = 5), within 2 weeks (<i>n</i> = 4), within 3 weeks (<i>n</i> = 3), within 30 days (<i>n</i> = 6), within 60 days (<i>n</i> = 5), and after 60 days (<i>n</i> = 9). The causes of death within 3 days were hypoxic encephalopathy, extensive burns (&gt;80%), severe heat stroke, and acute coronary syndrome. The causes of death after 3 days were sepsis, pneumonia, intestinal ischemia, pancreatitis, and worsening of chronic diseases. The mortality rate was similar for patients ≥65 years of age and those with a burn area of ≥20%, with both groups showing a particularly poor prognosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The timing of death in hospitalized burn patients showed a bimodal distribution as approximately 40% of patients who survived the resuscitation period died after 30 days. Elderly patients were at particularly high risk for mortality. In burn care, treatment planning should consider not only the short-term but also the long-term prognosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11211089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141465502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guidance for clinical practice using emergency and point-of-care ultrasonography","authors":"Toru Kameda,&nbsp;Hiromoto Ishii,&nbsp;Seiro Oya,&nbsp;Kenichi Katabami,&nbsp;Takamitsu Kodama,&nbsp;Makoto Sera,&nbsp;Hirokazu Takei,&nbsp;Hayato Taniguchi,&nbsp;Shunichiro Nakao,&nbsp;Hiraku Funakoshi,&nbsp;Satoshi Yamaga,&nbsp;Satomi Senoo,&nbsp;Akio Kimura","doi":"10.1002/ams2.974","DOIUrl":"10.1002/ams2.974","url":null,"abstract":"<p>Owing to the miniaturization of diagnostic ultrasound scanners and their spread of their bedside use, ultrasonography has been actively utilized in emergency situations. Ultrasonography performed by medical personnel with focused approaches at the bedside for clinical decision-making and improving the quality of invasive procedures is now called point-of-care ultrasonography (POCUS). The concept of POCUS has spread worldwide; however, in Japan, formal clinical guidance concerning POCUS is lacking, except for the application of focused assessment with sonography for trauma (FAST) and ultrasound-guided central venous cannulation. The Committee for the Promotion of POCUS in the Japanese Association for Acute Medicine (JAAM) has often discussed improving the quality of acute care using POCUS, and the “Clinical Guidance for Emergency and Point-of-Care Ultrasonography” was finally established with the endorsement of JAAM. The background, targets for acute care physicians, rationale based on published articles, and integrated application were mentioned in this guidance. The core points include the fundamental principles of ultrasound, airway, chest, cardiac, abdominal, and deep venous ultrasound, ultrasound-guided procedures, and the usage of ultrasound based on symptoms. Additional points, which are currently being considered as potential core points in the future, have also been widely mentioned. This guidance describes the overview and future direction of ultrasonography for acute care physicians and can be utilized for emergency ultrasound education. We hope this guidance will contribute to the effective use of ultrasonography in acute care settings in Japan.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11201855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed diagnosis in a child with strangulated mesenteric hernia","authors":"Kenichi Tetsuhara,&nbsp;Kazunobu Nakabayashi,&nbsp;Mamoru Muraoka,&nbsp;Rie Kikuno,&nbsp;Michiko Ueda,&nbsp;Ryo Inoue,&nbsp;Makoto Hayashida","doi":"10.1002/ams2.977","DOIUrl":"10.1002/ams2.977","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Strangulated intestinal obstruction is a life-threatening condition that should be considered as a differential diagnosis in children with shock. However, it has pitfalls in diagnosis and can lead to diagnostic errors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 3-month-old male patient presented with a pale complexion lasting 2 h and abnormal crying. He was in shock with lactic acidosis, altered mental status, and slight abdominal distension. He required volume resuscitation, vasoactive agents, and transfusion. On Day 2, he had marked abdominal distension and acute kidney injury, which required continuous kidney replacement therapy. Contrast-enhanced computed tomography revealed extensive intestinal ischemia. It took 33.5 h from his arrival to the computed tomography, leading to operative management. The small intestine had entered a mesenteric hiatus, leading to ischemia. He was diagnosed with strangulated mesenteric hernia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this case, four pitfalls led to delayed diagnosis. Factors for diagnostic errors specific to strangulated intestinal obstruction and intensive care should be noted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11184467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141417251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic immune response of burns from the acute to chronic phase","authors":"Akinori Osuka,&nbsp;Ayami Shigeno,&nbsp;Hiroshi Matsuura,&nbsp;Shinya Onishi,&nbsp;Kazuhiro Yoneda","doi":"10.1002/ams2.976","DOIUrl":"10.1002/ams2.976","url":null,"abstract":"<p>Immune responses that occur following burn injury comprise a series of reactions that are activated in response to damaged autologous tissues, followed by removal of damaged tissues and foreign pathogens such as invading bacteria, and tissue repair. These immune responses are considered to be programmed in living organisms. Developments of modern medicine have led to the saving of burned patients who could not be cured previously; however, the programmed response is no longer able to keep up, and various problems have arisen. This paper describes the mechanism of immune response specific to burn injury and the emerging concept of persistent inflammation, immunosuppression, and catabolism syndrome.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11184575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141417253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Migration of a pericardial drainage catheter into the right main pulmonary artery","authors":"Yuko Ono,&nbsp;Kauzaki Shinohara,&nbsp;Tokiya Ishida,&nbsp;Isamu Yamada,&nbsp;Joji Kotani","doi":"10.1002/ams2.968","DOIUrl":"10.1002/ams2.968","url":null,"abstract":"<p>Migration of a pericardial drainage catheter into the right main pulmonary artery. If clinical symptoms of cardiac tamponade are unresolved and dense hemorrhagic fluid is evacuated after pericardial drain placement, this rare but lethal complication is a possibility.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11183183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141417252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A well-managed case of discontinuous anorectal injury caused by a personal watercraft treated by combining surgery and colonoscopy","authors":"Hiraaki Okuzawa,&nbsp;Akira Endo,&nbsp;Tomohiro Akutsu,&nbsp;Keisuke Suzuki,&nbsp;Hiromasa Hoshi,&nbsp;Shunichiro Kato,&nbsp;Koji Ito,&nbsp;Yasuhiro Otomo,&nbsp;Koji Morishita","doi":"10.1002/ams2.972","DOIUrl":"https://doi.org/10.1002/ams2.972","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Anorectal injury caused by personal watercraft (PWC)-related trauma is rare. However, PWC accidents have increased recently, and since patients tend to be younger, treatment strategies should consider anal function preservation in addition to saving lives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 30-year-old female patient who fell into the water when a PWC suddenly accelerated and injured her perineum with a forceful water jet was transported to our hospital. On examination, she was diagnosed with a traumatic rectal perforation with intraperitoneal findings and an anorectal injury. Emergency surgery, which involved direct suturing, temporary colostomy with intraoperative endoscopy for the rectal perforation, and anorectal reconstruction, was performed. The patient was discharged on postoperative day 19 without complications, and the colostomy was closed 5 months postoperatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We encountered a case of multiple noncontinuous anorectal injuries due to a PWC accident that was successfully treated using a combination of surgery and intraoperative endoscopy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.972","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141326704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral air embolism followed by endoscopic balloon dilatation for esophageal strictures","authors":"Ryoichi Shoji,&nbsp;Naruaki Otake,&nbsp;Takeo Nagura,&nbsp;Jushi Numata,&nbsp;Junya Tsurukiri","doi":"10.1002/ams2.971","DOIUrl":"https://doi.org/10.1002/ams2.971","url":null,"abstract":"<p>A 59-year-old male patient underwent esophageal endoscopic balloon dilatation (BD) under sedation for esophageal strictures at another hospital. He suddenly became unresponsive post-procedure, resulting in coma and undergoing mechanical ventilation. Head computed tomography (CT) revealed multiple air emboli within the parenchyma, and cerebral air embolism (CAE) was diagnosed. Additionally, abdominal CT revealed air in the portal venous system. Diffusion-weighted magnetic resonance imaging after 2 days confirmed areas of acute ischemia involving the right frontal, temporal, and occipital lobes (Figure 1). Microbubble-enhanced echocardiography revealed no evidence of a cardiac shunt. His consciousness gradually improved over several days without undergoing hyperbaric oxygen therapy, and he was discharged for rehabilitation in left hemiplegia after 30 days.</p><p>CAE is a rare, potentially catastrophic iatrogenic complication.<span>¹</span> Four reports on esophageal endoscopic BD-induced CAE were retrieved from PubMed, but the pathogenesis without obtaining whole-body imaging remains unclear.<span>^2-5</span> The venous air embolism, including the portal vein and the cerebrum, explained the present case. This is the first report on the pathogenesis visualized as supporting evidence of CAE during endoscopic procedures. The mechanism includes air transgression from the esophageal mucosa to the vasculature and flowing into the portal venous system through portal–esophageal vein radicles transected during the procedure.</p><p>All authors declare that they have no conflict of interest, and the manuscript has not been previously published; the manuscript is not under consideration for publication elsewhere.</p><p>Approval of the research protocol: N/A.</p><p>Informed consent: Written informed consent was obtained from the patient for publication of this case report and accompanying images.</p><p>Registry and the registration no. of the study/trial: N/A.</p><p>Animal studies: N/A.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.971","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141326697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do-not-attempt-resuscitation orders, end-of-life care discussions, and advance care planning for deteriorating patients in Japan","authors":"Tatsuya Tsuji,&nbsp;Yoshiki Sento,&nbsp;Kazuya Sobue","doi":"10.1002/ams2.975","DOIUrl":"https://doi.org/10.1002/ams2.975","url":null,"abstract":"<p>We appreciate the interest and comments of Ogata et al. on our recently published article in <i>Acute Medicine and Surgery</i>.<span>^{1, 2}</span> We share the view of Ogata et al. that advance care planning (ACP) should be promoted in acute care hospitals. However, because data on patients with clinical deterioration are still lacking in Japan, we hope that similar research will continue to be shared among medical facilities. Therefore, we would like to highlight several issues that need to be addressed in future studies.</p><p>First, while our study provided a quantitative evaluation of the existence of DNAR orders for deteriorating patients, the quality of EOLC and the process of shared decision-making (SDM) could not be evaluated. Therefore, we could not provide deeper interpretations of the content of SDM with patients and their families regarding DNAR orders, EOLC, limitations of medical treatment, time-limited trials, or ACP.</p><p>Second, DNAR orders can change depending on the situation; perspectives; and values of patients, their families, and healthcare providers. We would like to highlight that an RRS resulted in not only new DNAR orders for patients without pre-existing DNAR orders but also the withdrawal of pre-existing DNAR orders.<span>¹</span> However, the current database includes outcomes at the point of deterioration or 1 month later and does not allow for long-term follow-up. As Ogata et al. pointed out,<span>²</span> the appropriate timing of SDM among patients and their families and the interpretation and handover of SDM among facilities are key considerations.</p><p>Third, we investigated the limitations of the medical treatment for pediatric patients with clinical deterioration in Japan.<span>³</span> Although cases in children were fewer than those in adults, we have demonstrated that the limitation of medical treatment was present in 6% of deteriorating children. This pediatric study underlines the potential utility of including healthcare providers in treatment teams as targets for training in pediatric ACP.</p><p>Fourth, the 2023 guidelines published by the Society of Critical Care Medicine recommend that responding healthcare providers should have expertise in facilitating the achievement of patients' goals of care and establishing treatment plans that best reflect their wishes and prognoses.<span>⁴</span> In the field of acute care medicine in Japan, many statements and guidelines have been published regarding EOLC, DNAR orders, and ACP, including the “Advice on Do Not Attempt Resuscitation (DNAR) order” by the “Japanese Society of Intensive Care Medicine in 2017 and the Guidelines for decision making with end-of-life care” by the Ministry of Health, Labour and Welfare in 2018. However, the contents of these guidelines have not been fully disseminated to the medical field and also proven to be clinically effective in encouraging SDM. Therefore, the outcomes bef","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.975","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141315390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triangular pyramidal configuration of three treads for ring removal","authors":"Katsuma Horio,&nbsp;Takeji Saitoh,&nbsp;Aiko Naruse,&nbsp;Hideyuki Arima,&nbsp;Atsuto Yoshino,&nbsp;Katsumasa Nakamura","doi":"10.1002/ams2.973","DOIUrl":"https://doi.org/10.1002/ams2.973","url":null,"abstract":"<p>A 40-year-old woman arrived at our emergency department with her wedding ring firmly stuck on her 4th digit after wearing it for a decade. Despite her attempts to remove it, the swollen finger tightly incarcerated the ring. First, we tried to get rid of the ring by simply pulling it off with lubricants. Several attempts were made to remove the ring without success. Subsequently, an elastic tape was tightly wrapped around the finger from its top to the ring, before we try to unwound proximal to the ring and pull it off. But the patient, allergic to lidocaine, felt itchy, and finally we abandoned these methods.</p><p>She rejected to cut the ring off. Consequently, three 1–0 silk threads, arranged like a triangular pyramid (Figure 1A), were threaded through the ring using a mosquito forceps. As one medical staff kept pulling two threads (the black arrows), another simultaneously pulled the remaining thread with one hand (the white arrow) while gently manipulating the ring and rubbing the finger from distal to proximal with the other hand. Eventually, the ring slowly slipped off, marking the first reported use of this three-string method for ring removal.</p><p>Conventional methods to remove a ring mainly consist of simple pulling with lubricants, binding a string or an elastic tape in the distal part of the finger,<span>^{1, 2}</span> exsanguinating a finger with a distal intravenous tourniquet,<span>³</span> and cutting a ring. The challenge lies in applying sufficient peripheral force without causing harm. The power to pull peripherally is important; however, clinicians cannot often give the proper power to a ring. The three-thread method stands out for its simplicity and effectiveness, likely becoming a common choice among clinicians. This method, especially when combined with finger-binding, offers a viable option for challenging cases. Based on this approach, we developed a device (Figure 1B) featuring a 3 mm wooden board with three attached nuts and screws. The threads are secured within the screws, and the device includes magnets to enhance pulling power with a metal wall. This innovation enables a single clinician to effortlessly remove a ring. The device holds promise as one of the evolving options for ring removal, offering a sleek and effective solution for challenging cases in the future.</p><p>None.</p><p>Approval of the research protocol: N/A.</p><p>Informed Consent: N/A.</p><p>Registry and the Registration No. of the study/Trial: N/A.</p><p>Animal Studies: N/A.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.973","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141298623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}