Strangulation

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Background

  • Strangulation
    • Hanging, ligature, manual or postural strangulation
    • Homicide, assault, suicide or execution
  • Mechanism of death/injury [1]
    • Spinal cord/brainstem injury
    • Mechanical compression
    • Bradycardia

Pathophysiology

  • Upper C-spine fractures
    • Judicial hanging, greater heights
  • Jugular venous obstruction
    • Cerebral congestion
    • Loss of consciousness
  • Arterial compression
    • Cerebral ischemia
  • Airway compression
    • Hypoxia
  • Carotid baroreceptor reflex
    • Bradycardic arrest

Clinical Features

Differential Diagnosis

Neck Trauma

Evaluation

  • CBC
  • Chem 10
  • PT/PTT
  • Type and screen
  • Lactate
  • VBG/ABG
  • EtOH, UTox
  • CT brain
  • CT cervical spine
  • CTA neck
  • CXR

Management

  • ATLS
  • Secure airway if indicated
    • Stridor/hoarseness suggests upper airway obstruction
  • Cervical spine immobilization
  • Cardiac monitoring
  • Antibiotics if aspiration present
  • PEEP for hypoxia
  • Levophed for neurogenic shock

Disposition

  • Observation warranted if awake, alert, no stridor
  • ICU
  • Psychiatric assessment

References

  1. Iserson, K. V. (1984) ‘Strangulation: A review of ligature, manual, and postural neck compression injuries’, Annals of Emergency Medicine, 13(3), pp. 179–185.