Strangulation

Background

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

Pathophysiology

• Upper C-spine fractures
  • 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
  • Delayed dementia, amnesia, psychosis

Work up

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