Strangulation: Difference between revisions
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*Strangulation | *Strangulation | ||
**Hanging, ligature, manual or postural strangulation | **Hanging, ligature, manual or postural strangulation | ||
**Homicide, assault, suicide or execution | **Homicide, assault, [[suicide]] or execution | ||
*Mechanism of death/injury <ref>Iserson, K. V. (1984) ‘Strangulation: A review of ligature, manual, and postural neck compression injuries’, Annals of Emergency Medicine, 13(3), pp. 179–185.</ref> | *Mechanism of death/injury <ref>Iserson, K. V. (1984) ‘Strangulation: A review of ligature, manual, and postural neck compression injuries’, Annals of Emergency Medicine, 13(3), pp. 179–185.</ref> | ||
**Spinal cord/brainstem injury | **Spinal cord/brainstem injury | ||
**Mechanical compression | **Mechanical compression | ||
**Bradycardia | **[[Bradycardia]] | ||
===Pathophysiology=== | ===Pathophysiology=== | ||
*Upper C-spine fractures | *Upper [[cervical Spine Injuries|C-spine fractures]] | ||
**Judicial hanging, greater heights | **Judicial hanging, greater heights | ||
*Jugular venous obstruction | *Jugular venous obstruction | ||
**Cerebral congestion | **Cerebral congestion | ||
**Loss of consciousness | **[[syncope|Loss of consciousness]] | ||
*Arterial compression | *Arterial compression | ||
**Cerebral ischemia | **Cerebral ischemia | ||
*Airway compression | *Airway compression | ||
**Hypoxia | **[[Hypoxia]] | ||
*Carotid baroreceptor reflex | *Carotid baroreceptor reflex | ||
**Bradycardic arrest | **[[bradycardia|Bradycardic]] [[cardiac arrest|arrest]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Facial petechiae | *Facial [[petechiae]] | ||
*Ecchymoses | *Ecchymoses | ||
*Airway | *Airway | ||
**Hoarseness | **[[dysphonia|Hoarseness]] | ||
**Stridor | **[[Stridor]] | ||
**Fracture of larynx, hyoid, thyroid cartilage | **Fracture of larynx, hyoid, thyroid cartilage | ||
**Laryngeal edema | **Laryngeal edema | ||
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**Aspiration [[pneumonia]] | **Aspiration [[pneumonia]] | ||
**[[Cardiac arrest]] | **[[Cardiac arrest]] | ||
**Bradycardia | **[[Bradycardia]] | ||
**[[Negative-pressure pulmonary edema (NPPE)]] | **[[Negative-pressure pulmonary edema (NPPE)]] | ||
*Neurologic | *Neurologic | ||
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**Cerebral anoxia | **Cerebral anoxia | ||
**Cerebral edema | **Cerebral edema | ||
**Delayed dementia, amnesia, psychosis | **Delayed [[dementia]], amnesia, [[psychosis]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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*PT/PTT | *PT/PTT | ||
*Type and screen | *Type and screen | ||
*Lactate | *[[Lactate]] | ||
*VBG/ABG | *[[VBG]]/[[ABG]] | ||
*EtOH, | *EtOH, [[Utox]] | ||
*CT brain | *[[CT brain]] | ||
*CT cervical spine | *CT cervical spine | ||
*CTA neck | *CTA neck | ||
| Line 64: | Line 64: | ||
*Cervical spine immobilization | *Cervical spine immobilization | ||
*Cardiac monitoring | *Cardiac monitoring | ||
*Antibiotics if aspiration present | *[[Antibiotics]] if aspiration present | ||
*PEEP for hypoxia | *PEEP for hypoxia | ||
*[[Levophed]] for neurogenic shock | *[[Levophed]] for neurogenic shock | ||
Revision as of 22:40, 30 September 2019
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
- Carotid baroreceptor reflex
Clinical Features
- Facial petechiae
- Ecchymoses
- Airway
- Hoarseness
- Stridor
- Fracture of larynx, hyoid, thyroid cartilage
- Laryngeal edema
- Cardiopulmonary
- Neurologic
- Spinal cord trauma
- Hangman's fracture uncommon
- Neurogenic shock
- Cerebral anoxia
- Cerebral edema
- Delayed dementia, amnesia, psychosis
Differential Diagnosis
Neck Trauma
- Penetrating neck trauma
- Blunt neck trauma
- Cervical injury
- Neurogenic shock
- Spinal cord injury
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.