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Strangulation
From WikEM
Contents
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
- Facial petechiae
- Ecchymoses
- Airway
- Hoarseness
- Stridor
- Fracture of larynx, hyoid, thyroid cartilage
- Laryngeal edema
- Cardiopulmonary
- Aspiration pneumonia
- Cardiac arrest
- Bradycardia
- Neurogenic pulmonary edema
- Neurologic
- Spinal cord trauma
- Hangman's fracture uncommon
- Neurogenic shock
- Cerebral anoxia
- Cerebral edema
- Delayed dementia, amnesia, psychosis
Differential Diagnosis
Blunt Neck Trauma
- Spinal cord trauma
- Vertebral and carotid artery dissection
- Whiplash injury
- Cervical spine fractures and dislocations
- Strangulation
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
- ↑ Iserson, K. V. (1984) ‘Strangulation: A review of ligature, manual, and postural neck compression injuries’, Annals of Emergency Medicine, 13(3), pp. 179–185.
Authors
Kian Preston-Suni, Ross Donaldson, Neil Young, Claire, Daniel Ostermayer
