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Describe the pathophysiology of strangulation injuries. Any overdoses or metabolic disturbances warrant their specific and appropriate antidotes or symptomatic therapeutic interventions. Publication types Case Reports. The nature of the hanging injury informs the type of pathophysiology.


Strangulation Injuries – StatPearls – NCBI Bookshelf – Continuing Education Activity


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In other projects. Wikimedia Commons. On this Wikipedia the language links are at the top of the page across from the article title. Go to top. Contents move to sidebar hide. Article Talk. Read Edit View history. More Read Edit View history. Compression of the neck that may lead to unconsciousness or death. For bowel strangulation, see Strangulation bowel. For domestic violence strangulation, see Strangulation in domestic violence. For the options strategy, see Strangle options. For the film, see Strangled film.

Not to be confused with Choking. Further information: chokehold. Look up strangling in Wiktionary, the free dictionary. Main article: Garrote. Retrieved 3 March Archived from the original on 4 January Archived from the original on 26 February Archived from the original on 30 April Retrieved 30 April Archived from the original on 27 September How Safe is Choking in Judo?

URL last accessed 3 March Death from law enforcement neck holds. Carotid Sinus reflex death – a theory and its history. URL last accessed 28 February CT is widely available and is the first line of radiologic evaluation of strangulation injuries. CT Angiogram of the carotid and vertebral arteries is the gold standard in care.

This allows for the evaluation of vascular and bony structures. CT of the neck with contrast is less specific than CT Angiogram but will evaluate bony structures and vascular structures to a degree. Non-contrast CT of the brain will evaluate for stroke but is more sensitive for intracranial hemorrhage than for smaller ischemic strokes.

A non-contrast CT scan of the brain may identify large areas of infarcted tissue. Non-contrast CT is also the study of choice to evaluate for cerebral edema in the acutely presenting patient. MRA of the neck is another imaging modality option, although it is less available in smaller and rural centers, and it is also more time-consuming than CT to complete. It is also less sensitive than CTA of the neck in evaluating vessels.

MRI of the neck poses similar availability issues. It has less sensitivity than CTA in evaluating vascular structures; however, it is the most accurate study to evaluate the soft tissues of the neck. Consideration must be given to the patient’s clinical stability before pursuing magnetic resonance-based studies.

Carotid doppler is not recommended for the evaluation of strangulation injuries due to its inability to completely evaluate all of the possibly affected vascular structures. Plain chest radiography is also recommended in patients who have required intubation or are in respiratory distress.

Indications include various signs of aerodigestive injury including hemoptysis and hematemesis. Immediate resuscitative interventions should take priority over radiologic studies. Clinicians who practice in settings where they are responsible for acute management of patients suffering from strangulation must have extensive experience in airway management, including surgical techniques emergent tracheostomy and cricothyrotomy.

Patients with “hard signs” or other physical exam findings of extensive cervical injury should immediately have a cervical collar or other immobilization device placed.

Removal can only occur once appropriate clinical and radiographic approaches have ruled out unstable fractures, vascular injury, and other threatening pathology. After evaluation in the emergency department, the patient may be discharged with strict return precautions. Asymptomatic patients may be discharged after Emergency Department evaluation with strict return precautions and in-home monitoring by family or friends.

Symptomatic patients with normal radiologic studies should either be admitted to the hospital or the emergency department observation unit, if available, for further monitoring. Admitted patients require a multidisciplinary approach depending on the extent of their injuries.

Delayed pulmonary edema and complications from concomitant musculoskeletal trauma may become of particular importance and thus specialty and organ-specific care must be sought. Generally, the prognosis for patients who have minimal to no external signs and with unremarkable radiologic workups is favorable.

In terms of traumatic sequelae delayed vascular findings are of importance, however with current imaging technology these cases are rare. The prognosis for these patients then becomes a matter of the psychosocial reasons that may have resulted in the injury, and depend on mitigation of exposure. Severely injured patients, and those with particularly devastating signs of neurological injury, tend to do much worse. Prognosis depends heavily on the extent and duration of anoxic brain injury, and long term recovery depends upon the specific areas of the brain involved.

While patients with a low Glasgow Coma Scale tend to do worse, initial neurological conditions do not exclude a favorable recovery. Patients presenting in cardiac arrest tend to have a very grave prognosis. Various specialty services may be required to manage strangulation injuries. Cerebral edema with impending herniation and cases involving spinal cord compromise or other neurological injuries may require neurosurgical intervention.

Orthopedic surgeons with spine surgery fellowship training may be required for certain injuries. Vascular compromise, depending on the type and extent, may require a vascular surgeon or interventional radiologist.

Tracheal injuries can be repaired by otolaryngology. Critically ill patients will require the care of a trained intensivist — skilled ventilator management is crucial for optimal recovery in this patient population. Once recovered, or if initial injuries are minimal, mental health experts and psychiatric care should be considered depending on case specifics. Long term neurological sequelae are best handled in conjunction with a trained neurologist. Given that strangulation injuries may be a result of a suicide attempt, patients may necessitate being placed on a psychiatric hold or need immediate emergency department psychiatric evaluation.

These patients also require that suicide precautions be taken if admitted to the hospital. Strangulation injuries may also be a result of a criminal act. When these patients present to the emergency department, notification of the appropriate law enforcement agencies should also occur per local laws, policies, and procedures.

The care of a patient who has suffered from a strangulation injury requires a dedicated multidisciplinary approach. Patients with abnormal radiologic studies should be admitted to the hospital to the appropriate level of nursing care. The patient may require various levels of care depending on the nature of the injury — telemetry, step-down units, or the intensive care units may all play a part in management. Specialists should also be consulted based on specific injuries.

This may include trauma surgery, neurosurgery, neurology, otolaryngology, and psychiatry. Any overdoses or metabolic disturbances warrant their specific and appropriate antidotes or symptomatic therapeutic interventions.

Wound care specialists may be critical for the long term management of various injuries. Additionally, social workers and law enforcement may play an important role.

Religious and spiritual preferences of the patient and involved families may require a versatile chaplain or other spiritual and religious leaders. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

Turn recording back on. Help Accessibility Careers. StatPearls [Internet]. Search term. Strangulation Injuries Roberta J. Affiliations 1 Riverside Community Hospital. Continuing Education Activity Strangulation injuries occur when external forces are applied to the neck leading to a variety of traumatic pathology. Introduction Strangulation injuries are a heterogeneous set of traumatic pathology that occurs as a result of mechanical force applied externally to the neck and surrounding structures.

Etiology Strangulation is defined as the compression of blood or air-filled structures which impedes circulation or function. Epidemiology The true prevalence and incidence of all-cause strangulation injuries and mortality is unknown. Pathophysiology The common pathway through which strangulation injuries cause morbidity and mortality is via cerebral hypoxemia and resultant cerebral ischemia. Backpressure prevents eventual arterial inflow and results in elevated intracranial pressures.

This ultimately results in unconsciousness, depressed brainstem functions, and ultimately asphyxia and death. External pressure to the carotid arteries directly prevents oxygenated blood flow to the cerebral vasculature which leads to asphyxia and death. Pressure obstruction of the larynx primarily results in the inability to oxygenate the pulmonary vasculature.

Systemic hypoxia quickly ensues of which the most pronounced effects are rapid loss of consciousness followed by death. Though rare, cardiac dysrhythmias may occur with pressure directed towards the carotid bodies bilaterally. This has the potential to evoke cardiac arrest, and subsequent death if not promptly recognized.

Histopathology Histopathological implications of strangulation injuries are as diverse as the pathophysiology that underlies each specific type and the conditions present at the time of injury.

Toxicokinetics Strangulation injuries, whether accidental or intentional may also be compounded by toxicological pathology. History and Physical The history of a strangulation injury may be obtained from the patient, witnesses, family or friends, first responder personnel, or a combination of the above.

Evaluation Once the patient is stabilized, laboratory and radiologic studies can aid in determining the severity of the injury. Differential Diagnosis Anaphylaxis.

Prognosis Generally, the prognosis for patients who have minimal to no external signs and with unremarkable radiologic workups is favorable. Consultations Various specialty services may be required to manage strangulation injuries.

Pearls and Other Issues Given that strangulation injuries may be a result of a suicide attempt, patients may necessitate being placed on a psychiatric hold or need immediate emergency department psychiatric evaluation. Enhancing Healthcare Team Outcomes The care of a patient who has suffered from a strangulation injury requires a dedicated multidisciplinary approach.

Review Questions Access free multiple choice questions on this topic. Comment on this article. References 1. Non-fatal strangulation is an important risk factor for homicide of women.

J Emerg Med. J Womens Health Larchmt. Hlavaty L, Sung L. Am J Forensic Med Pathol. Sendler DJ. Lethal asphyxiation due to sadomasochistic sex training – How some sex partners avoid criminal responsibility even though their actions lead to someone’s death. J Forensic Leg Med. Spinal injuries in children. J Pediatr Surg. Sep D, Thies KC. Strangulation injuries in children.

Glob Pediatr Health. Stud Health Technol Inform. De Boos J. Review article: Non-fatal strangulation: Hidden injuries, hidden risks. Emerg Med Australas. Under-five mortality from unintentional suffocation in China, J Glob Health. Relevant findings on postmortem CT and postmortem MRI in hanging, ligature strangulation and manual strangulation and their additional value compared to autopsy – a systematic review. Forensic Sci Med Pathol. Todd NV. Priapism in acute spinal cord injury.

Spinal Cord. Airway and respiratory management following non-lethal hanging. Can J Anaesth. Injuries over neck in hanging deaths and its relation with ligature material: is it vital? Part 1. Clinical analysis. J Trauma. Rauchschwalbe R, Mann NC. Pediatric window-cord strangulations in the United States, A descriptive analysis of children’s playground injuries in the United States Inj Prev. Cowell DD. Autoerotic asphyxiation: secret pleasure–lethal outcome? The relationship between serial sexual murder and autoerotic asphyxiation.

Forensic Sci Int. There is more to the mechanism of unconsciousness from vascular neck restraint than simply carotid compression. Int J Neurosci. Bachmann S. Epidemiology of Suicide and the Psychiatric Perspective. Praxis Bern Am Surg. A review of attempted strangulation cases. Part I: criminal legal issues. Menon KV, Taif S. Detailed description of anatomy of the fracture line in hangman’s injury: a retrospective observational study on motor vehicle accident victims.

Br J Radiol. Near-hanging injuries: a year experience. Hypoxic-ischemic brain injury: pathophysiology, neuropathology and mechanisms. Emergency airway management in hanging victims. Ann Emerg Med. Evaluation of Nonfatal Strangulation in Alert Adults. Weaning difficulty in a near hanging patient: An unusual cause.

Lung India. J Emerg Nurs. Postobstructive pulmonary edema following accidental near-hanging. Am J Case Rep. Strangulation Injuries.

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