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Question: Extremity

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A 9 month old baby is brought in with this problem, first noted a few hours prior.

Hair tourniquet

By James Heilman, MD [CC BY-SA 3.0 ( or GFDL (], from Wikimedia Commons

What is your best course of action?

pemsou5_wp • July 17, 2018

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  1. Kelly July 17, 2018 - 4:42 pm Reply

    E) Perform digital block and make incision at lateral toe (9:00 o’clock position)
    This is a hair tourniquet. The hair or thread can quickly become deeply buried in the tissue of fingers, toes, the penis, and more rarely, the clitoris, labia minora, and uvula. First attempts at removal include using a blunt instrument to lift the hair and snip it with sharp iris scissors. But, if that is unsuccessful an incision to the bone may be necessary to cut the hair. Neurovascular bundles are at the 1:30, 4:30, 7:30, and 10:30 positions, so incisions are best made dorsally (12:00) or laterally 3:00 or 9:00. For more information from Larry Mellick’s M2E Too! Blog on EM News, and a link to a video:

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