Nik Ahmad Shaiffudin Nik Him


Nik Ahmad Shaiffudin Nik Him1 , Nik Arif Nik Mohamad1, Rosliza Yahaya1 , Azizul Fadzli Jusoh1, Amirah A Rashid2, Mohd Lotfi Hamzah2

1Faculty of Medicine, University Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia

2Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu , Malaysia



Emergency care provider (ECP) managing schizophrenia will deal with many challenges, not only during acute clinical management but also post discharged from Emergency Department (ED). Failure to anticipate the possible risk or harm will cause an unnecessary permanent injury resulting in a substandard management of the patient and even death.


Case report

We present a case of an abusive relapse schizophrenia on treatment in a middle age man with a previous history of right fifth finger self-amputation due to gangrene resulting from constricting ring post two weeks after discharged from ED. Initially, he was referred by a psychiatrist to orthopedic team for underlying soft tissue infections of the hand but was advised to direct the patient to ED as he was noted to be moderately hypertensive and tachycardia. We removed nine (9) constricting rings from the fingers of both hand using an oscillating saw and ring cutter under prosedural sedation combined with wrist block in ED. An immediate released of the constriction had saved his ischemic fingers.


Discussion & Conclusion

ECP caring for the schizophrenia is mandate to anticipate the possible harm and not only to communicate to family member but also to take preventable remedial steps. However, the possible risk of negligence should be kept in mind bearing a link with depression among family members caring for schizophrenia. This case illustrates the early recognition and intervention had successfully restored the circulation of the ischemic fingers thus avoid the amputation of the fingers.



constriction ring, emergency care providers, schizophrenia

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