Strangulation

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

Clinical Features

Differential Diagnosis

Neck Trauma

Evaluation

  • CBC
  • Chem 10
  • PT/PTT
  • Type and screen
  • Lactate
  • VBG/ABG
  • EtOH, Utox
  • CT brain
  • CT cervical spine
  • CTA neck criteria from Taming of the Sru Grand Rounds [2]directly quoted below:
    • Guidelines for imaging: GCS<8, audible neck bruit, expanding neck hematoma, focal neurologic deficit (including TIAs, Horner’s syndrome, vertebrobasilar syndrome), arterial bleeding from nose, mouth, neck
      • OR consider adding on if high C spine fracture, cervical vertebral body or fracture through foramen transversarium, subluxation or ligamentous injury at any level, significant thoracic/cardiac blunt force trauma, LeFort II or III fractures, skull base fracture, diffuse axonal injury
      • CTA neck AND head (can miss top of carotids with just 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

  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.
  2. Taming of the Sru Grand Rounds Recap 11.6.19 accessed 11/25/2019. Copy permission given by CC BY-NC-SA 4.0 license Taming of the Sru Website