Victims of strangulation/hanging require emergent evaluation due to the structures in the neck that could have obtained injury (trachia, hyoid bone, vocal cords, blood vessels, and brain from lack of blood flow).
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| image by thetombstonesnake courtesy of Flickr via baratunde.com |
If the victim was hanged, it is important to know the height from which they dropped. If if was equal to or greater than their height, there is a high probability of C-spine injury. Therefore, these patients need to be placed in a C-collar until such injury is ruled out.
Remember, there may few external signs of injury. This doesn't rule out significant damage. However, there may be signs of bruising around the neck and petechia above the point of the ligature. There may also be bleeding in the eye, changes to the voice. Symptoms may range from general soreness to difficulty breathing.
Other signs and symptoms include:
1. Difficulty swallowing.
2. Mental Status Changes: may indicate a period where the brain has gone without oxygen.
3. Miscarriage
4. Swelling of the neck
5. Lung Injury: if the patient vomited during strangulation.
6. Chin Abrasions: from the victim trying to protect their neck.
7. Defensive wounds to the neck from the victim tryng to break free.
How do we care for this patient? History of the event will be paramount in helping the physician determine what tests to run. Hopefully the patient will be able to supply pertinant information.
1. Baseline vital signs including continuous monitoring of the patient's oxygen level.
2. Assessment of neurological (did the patient lose consciousness, are they neurologically intact?), respiratory (are they having difficulty breathing) and cardiovascular systems.
3. If the patient was hanged-- they will need X-rays of the spine to rule out fracture as well as soft tissue films of that area. If they were strangled, soft tissue films of the neck are still warranted.
4. Direct Laryngoscopy: Visualizing the vocal cords to look for damage.
5. CT of the brain: if the patient was unconcious at any point.
6. CT/MRI scan of the neck: to look for soft tissue/vascular injury.
7. Chest x-ray: aid in diagnosis of aspiration.
8. Carotid Doppler: Looking at the neck vessels with ultrasound to look for injury and clots as a result of the attack.
This patient, depending on their severity of injury, could be observed in the emergency department for several hours and sent home or intubated out of concern for further airway compromise and admitted into the ICU. There is a lot of lattitude for the writer here.
Resources:
General Overview: http://emedicine.medscape.com/article/826704-overview
Wisconsin Medical Journal: Strangulation Injuries http://www.wisconsinmedicalsociety.org/_WMS/publications/wmj/pdf/102/3/41.pdf
Emergency Medicine Reports: Strangulation Injuries. http://www.ahcmedia.com/public/samples/emr.pdf:
How to Improve Your Investigation and Prosecution of Strangulation Cases. http://www.ncdsv.org/images/strangulation_article.pdf:
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