THE LORD OF THE SPROCKET: A REMOVAL OF CONSTRICTING TRAPPED SEVEN TOOTH SPROCKET ON FINGER USING THE CATERPILLAR TECHNIQUE UNDER PROCEDURAL SEDATION ANALGESIA.

Abstract

Introduction:

The caterpillar technique for removal of a tight ring has been described and proved to be efficient by Dr Carla St. Laurent even when other methods failed. However, we can not find any reported case of using this method for removal of object other than ring that stucked on the finger. 

Case Report:

We describe a case of 8-year-old boy  with no known medicall illness who has been playing with the seven tooth sprocket. Impressed by the architecture, he decided to put it on his ring finger eventhough it was tight. However, it became stucked, constricting and extremely painful by the time he presented to casualty which was about 12 hours post event.

Result:

Various method of removal failed including by using the cutter by the fire fighter brigade.  At that time, the diamond cutter was not available. He was sedated with IV Ketamine 1mg/kg and the seven tooth sprocket was successfully removed in less than one minute.

Discussion:

The successful of the original technique was being attributed to the use of excessive lubricant together with correct technique applied. However, this case poses a difficult challenge as the injury was neglected for more than 12 hours. As the object was very constricting and causing local tissue injury, the use of procedural sedation analgesia had facilitated the removal under the Caterpillar Technique.

Conclusion:

Administration of procedural sedation analgesia can increase the success rate for removal of the  extremely constricting ring-like structure on finger using the caterpillar technique. This technique should be considered early in order to minimize tissue damage caused by the constricted ring as well as providing comfort to the patient.