TY - JOUR
T1 - A comparison of two techniques for tungsten carbide ring removal
AU - Gardiner, Carolyn L.
AU - Handyside, Krista
AU - Mazzillo, Justin
AU - Hill, Mandy J.
AU - Reichman, Eric F.
AU - Chathampally, Yashwant
AU - King, Brent R.
PY - 2013/10
Y1 - 2013/10
N2 - Introduction Emergency physicians may have difficulty removing modern rings made of hard metals such as titanium and tungsten carbide. These metals are exceptionally difficult or impossible to remove using standard ring cutters. Numerous alternative techniques for removal have been described, including the "umbilical tape" or "string technique" and, in the case of tungsten carbide, breaking the ring using locking pliers. Objective We sought to compare the speed and effectiveness of tungsten carbide ring removal using these two techniques. Methods Ten tungsten carbide rings were placed upon the finger of a standard medical simulation mannequin. The rings chosen were one-half size smaller than the mannequin's finger. Edema distal to the ring was simulated using foam tape. A single novice operator performed 10 trials using each of the techniques after a 10-minute orientation session. The success or failure of the technique and the time for removal were recorded for each trial. The mean removal times for the trials were compared using a paired t test. Results All trials were successful. The rings were removed substantially faster using the locking pliers method (mean 23.1 seconds [95% CI 15.4-30.8] vs. mean 135.4 seconds [95% CI 130.2-150.6]). However, the locking pliers technique destroyed all rings and caused sharp ring fragments to be thrown up to 37 in. Conclusions Both the umbilical tape or string technique and the locking pliers technique successfully removed tungsten carbide rings in our model. The locking pliers technique is significantly faster but destroys the ring and creates potentially harmful shrapnel.
AB - Introduction Emergency physicians may have difficulty removing modern rings made of hard metals such as titanium and tungsten carbide. These metals are exceptionally difficult or impossible to remove using standard ring cutters. Numerous alternative techniques for removal have been described, including the "umbilical tape" or "string technique" and, in the case of tungsten carbide, breaking the ring using locking pliers. Objective We sought to compare the speed and effectiveness of tungsten carbide ring removal using these two techniques. Methods Ten tungsten carbide rings were placed upon the finger of a standard medical simulation mannequin. The rings chosen were one-half size smaller than the mannequin's finger. Edema distal to the ring was simulated using foam tape. A single novice operator performed 10 trials using each of the techniques after a 10-minute orientation session. The success or failure of the technique and the time for removal were recorded for each trial. The mean removal times for the trials were compared using a paired t test. Results All trials were successful. The rings were removed substantially faster using the locking pliers method (mean 23.1 seconds [95% CI 15.4-30.8] vs. mean 135.4 seconds [95% CI 130.2-150.6]). However, the locking pliers technique destroyed all rings and caused sharp ring fragments to be thrown up to 37 in. Conclusions Both the umbilical tape or string technique and the locking pliers technique successfully removed tungsten carbide rings in our model. The locking pliers technique is significantly faster but destroys the ring and creates potentially harmful shrapnel.
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U2 - 10.1016/j.ajem.2013.07.027
DO - 10.1016/j.ajem.2013.07.027
M3 - Article
C2 - 24012424
AN - SCOPUS:84885192189
SN - 0735-6757
VL - 31
SP - 1516
EP - 1519
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
IS - 10
ER -