Ring removal is indicated in a number of clinical circumstances to manage or prevent tourniquet effect of the digit. A ring made from hardened metal may defy commonly known methods of removal. We reported a case of unusual difficulty in removing a ring of hardened metal composition using a dental drill. We believed the unusual circumstances of this case is likely to be repeated in some other clinical practice and this instrument is an appropriate option to consider in such cases.

Background: Good coronary care begins from the patient's home, including early transportation. As such, it is recommended that the patients activate ambulances, rather than to use their own transportations to reach the hospitals. It is not known whether Malaysian patients prefer to use private transportations or ambulances when they develop chest pain. Objectives: This study is conducted to explore the question of the choice of transportation modes among patients with acute coronary syndrome and the reasons behind their choices. Methods: This is a structured interview survey on patients diagnosed with acute coronary syndrome (ACS) in emergency department of Hospital Universiti Sains Malaysia from April 2012 to September 2012. Results: Out of the 110 patients surveyed, 105 (95.5%) patients chose to use own transportation when they developed symptoms suggestive of ACS. Only 3 patients (2.7%) came to the emergency department within 1 hour of onset, and all these 3 patients chose to use ambulances as their modes of transportation. None of the patients who chose own transportation came within the first hour of symptoms onset. This is shown to be statistically significant (p<0.001). The level of education as well as past history of ischemic heart disease did not significantly influence the patients’ choice of transportation. Conclusion: The admonishment by various international resuscitation councils that patients with chest pain should be transported via ambulances may not be as straightforward as it seems. Numerous local and regional socio-cultura and logistic factors may need to beaddressed.
Acute Coronary Syndrome ; Emergency Service, Hospital

Introduction: Do Not Resuscitate (DNR) order is a type of Advance Medical Directive (AMD) that documents a patient’s wishes or desire to refrain from Cardiopulmonary Resuscitation (CPR), especially in the terminally ill patient. It is a sensitive issue in patient care and less is known on medical students awareness on the area. Aim: This study assessed the opinion, knowledge, awareness and familiarity toward Do Not Resuscitate (DNR) order among undergraduate medical students from year 1 to 5 in Universiti Sains Malaysia. Methods: A cross-sectional study was conducted with 250 undergraduate medical students using an online questionnaire on awareness towards DNR orders. Descriptive statistics, independent t-test and one-way ANOVA were applied to examine the distribution and association of DNR awareness among medical students with year of study, gender, race and religion. Results: The study indicated that most participants (84.4%) were familiar with DNR orders. There was no significant association between all 4 variables (year of study, gender, race and religion) with level of awareness among undergraduate medical students in HUSM. Conclusion: Undergraduate medical students have a good awareness on DNR orders. Despite having a multiracial and multi religion community, the medical students have similar patterns in their knowledge about DNR.