II. Definitions
-
Strangulation
- External neck compression affecting underlying large vessel perfusion or tracheal airflow
- Hanging
- External neck compression generated from force of gravitational pull on body weight
- Incomplete Hanging
- Hanging in which feet touch the ground (attempted Suicide)
- Complete Hanging
- Hanging in which feet do not touch the ground (judicial hanging)
- Associated with Cervical Spine Fracture and other head and neck Trauma
III. Epidemiology
IV. Pathophysiology
- Suicidal Hanging mechanism for death
- Vascular Occlusion with secondary anoxic brain injury (most common)
- Vertebral Artery Dissection, Cervical Spine injuries, Laryngeal Fractures may also occur, but are less common
- Judicial hanging mechanism for death
- Cervical Spine Fracture
- Airway injury
- Arterial dissection
V. Symptoms
- See Strangulation
- Odynophagia
- Dysphagia
- Dysphonia
- Stridor
- Dyspnea
VI. Signs
- See Strangulation
- Ligature marks
- Facial Petechiae
- Subconjunctival Hemorrhage
VII. Imaging
-
Chest XRay
- Evaluate for Interstitial Edema (Acute Respiratory Distress Syndrome or ARDS)
- Evaluate for Aspiration Pneumonitis
-
CT Head
- Indicated in Altered Mental Status
- CT Angiogram Neck (CTA neck)
- See Strangulation for indications
- Evaluate for Carotid Artery Dissection, Laryngeal Fracture, Cervical Spine Fracture, Hemorrhage
- Carotid ArteryUltrasound may be considered as an alternative in some cases
- Precautions
- Advanced imaging was negative in Near-Hanging survivors with normal GCS and normal exam (without tenderness)
- However, in clear cases of Near-Hanging or Strangulation imaging including neck CTA is typically recommended
VIII. Management
- See ABC Management
- See Trauma Evaluation
-
Cervical Spine and Airway
- Cervical Spine Immobilization
- Protect C-Spine throughout evaluation and Resuscitation (including during Endotracheal Intubation)
- Endotracheal Intubation Indications
- See Endotracheal Intubation for all indications
- Airway obstruction (e.g. Stridor)
- Impending airway compromise (e.g. subcutaneous Emphysema, Laryngeal Fracture)
- Respiratory insufficiency or distress (e.g. Hypoxemia)
- Altered Mental Status (e.g. Glasgow Coma Scale 8)
- Consider Cricothyrotomy in failed airway
- Cervical Spine Immobilization
- Cardiopulmonary
- Manage Acute Respiratory Distress Syndrome (ARDS)
- See Lung Protective Ventilator Strategy
- Avoid excessive fluid infusion
- Monitor for cardiovascular adverse effects
- Cardiac monitoring for Dysrhythmia
- Avoid excessive fluid infusion (see ARDS above)
- Hypotension suggests other cause beyond Near-Hanging
- Manage Acute Respiratory Distress Syndrome (ARDS)
- Manage Increased Intracranial Pressure in Closed Head Injury
- Associated Injuries and Ingestions
- See Unknown Ingestion
- Perform toxicology evaluation for Unknown Ingestions
- Additional measures
- Consider Corticosteroids in laryngeal edema
- Consider antibiotics in subcutaneous Emphysema or aspiration
- Seizure Prophylaxis in anoxic brain injury
- Disposition
- Admit all symptomatic patients to the Intensive Care unit
- Asymptomatic patients may be cleared for mental health admission after full medical evaluation
IX. Prognosis
- Cardiac Arrest is associated with poor prognosis and high mortality
- Neurologic outcome is not predicted by presenting neurologic status
- Recovery from severe neurologic deficit on presentation may occur with good supportive care
- However, delayed presentations are associated with worse outcomes
- References
X. References
- Swadron and Inaba in Swadron (2022) EM:Rap 22(5): 4-8
- Schellenberg (2019) J Trauma Acute Care Surg 86(3):454-7 +PMID: 30444857 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Injury or Poisoning (T037) |
| ICD9 | E953.0 |
| English | Injury-hanging, Suicide and self-inflicted injury by hanging |
Ontology: Attempted suicide - hanging (C0564920)
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 158067005, 287181000 |
| Spanish | intento de suicidio - ahorcamiento (evento), intento de suicidio - ahorcamiento (hallazgo), intento de suicidio - ahorcamiento |
| English | attempted suicide by hanging (diagnosis), attempted suicide by hanging, suicide attempt by hanging, Attempted suicide - hanging, Attempted suicide - hanging (finding), Attempted suicide - hanging (event) |
Ontology: Asphyxiation by hanging (C1268608)
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 129674006 |
| Spanish | asfixia por ahorcamiento (evento), asfixia por ahorcamiento (hallazgo), asfixia por ahorcamiento |
| English | Asphyxiation by hanging, asphyxia; hanging, hanging; asphyxia, Asphyxiation by hanging (finding), Asphyxiation by hanging (event) |
| Dutch | asfyxie; ophanging, ophanging; asfyxie |
