Strangulation: Difference between revisions

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[[category:Trauma]][[category:Head and Neck]]
[[category:Trauma]][[category:ENT]]

Revision as of 03:00, 13 June 2015

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
    • 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

Work up

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

Treatment

  • ATLS
  • Secure airway if indicated
    • Stridor/hoarseness suggests upper airway obstruction
  • Cervical spine immobilization
  • Cardiac monitoring
  • ABX if aspiration present
  • PEEP for hypoxia
  • Levophed for neurogenic shock

Disposition

  • Observation warranted if awake, alert, no stridor
  • ICU

Sources

  1. Iserson, K. V. (1984) ‘Strangulation: A review of ligature, manual, and postural neck compression injuries’, Annals of Emergency Medicine, 13(3), pp. 179–185.