Hanging Injuries and Strangulation Follow-up

  • Author: William Ernoehazy Jr, MD, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Nov 28, 2011
 

Further Inpatient Care

  • All patients who have required endotracheal intubation for airway management must be admitted to a critical care unit.
  • Even if the initial presentation is clinically benign, all near-hanging victims and patients with evidence of vascular compromise secondary to strangulation should be admitted for 24 hours observation to watch for delayed airway and pulmonary complications.
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Further Outpatient Care

  • Psychiatric support for near-hanging survivors is recommended, as these patients are prone to depression, personality disorders, and violence.
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Inpatient & Outpatient Medications

  • Phenytoin may help to prevent additional insult from cerebral ischemia and to treat hanging-induced seizures.
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Transfer

  • Once stabilized, patients who have sustained a spinal cord injury should be transferred to a designated spinal cord center.
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Deterrence/Prevention

  • Caution parents about the dangers of postural asphyxiation in toddlers. Encourage childproofing of the home.
  • Patients who present with injuries caused by "breath play," either autoerotic or thrill-seeking, should be educated in the risks of sudden death, which can occur.
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Complications

  • Respiratory complications: These are the major cause of delayed mortality in near-hanging victims. Both aspiration pneumonia and ARDS may develop, complicating the clinical course.
  • Tracheal stenosis
  • Neurologic sequelae: A wide array of complications may occur in survivors of strangulations and near-hangings, including muscle spasms, transient hemiplegia, central cord syndrome, and seizures.[7] Spinal cord injury can also cause long-term paraplegia or quadriplegia and short-term autonomic dysfunction.
  • Scarring of neck tissue
  • Psychiatric disturbances: Psychosis, Korsakoff syndrome, amnesia, and progressive dementia all have been reported after surviving a hanging or strangulation. Nearly all patients who have undergone strangulation or near-hanging demonstrate restlessness and a propensity for violence.
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Prognosis

  • The prognosis for survivors of hanging and strangulations is widely variable.
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Contributor Information and Disclosures
Author

William Ernoehazy Jr, MD, FACEP  Medical Director, Emergency Department, Ed Fraser Memorial Hospital, Florida

William Ernoehazy Jr, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Dan Danzl, MD  Chair, Professor, Department of Emergency Medicine, University of Louisville Hospital

Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David B Levy, DO, FACEP, FAAEM  Chairman, Department of Emergency Medicine, St Elizabeth Health Center; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Informatics Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

I wish to recognize the inspiration and help given by my father, Dr. William Ernoehazy, FACP (d. 2005), co-author of the original version of this article.

References

  1. National Center for Injury Prevention and Control. WISQARS Injury Mortality Reports, 1999 - 2005. WISQARS (Web-based Injury Statistics Query and Reporting System) Home. Available at http://webappa.cdc.gov/sasweb/ncipc/mortrate10_sy.html. Accessed 12/09/2007.

  2. Shah A, Buckley L. The current status of methods used by the elderly for suicides in England and Wales. J Inj Violence Res. Jul 2011;3(2):68-73. [Medline]. [Full Text].

  3. Sarma K, Kola S. The socio-demographic profile of hanging suicides in Ireland from 1980 to 2005. J Forensic Leg Med. Oct 2010;17(7):374-7. [Medline].

  4. Dunsby AM, Davison AM. Causes of laryngeal cartilage and hyoid bone fractures found at postmortem. Med Sci Law. Apr 2011;51(2):109-13. [Medline].

  5. Mills PD, Watts BV, Derosier JM, Tomolo AM, Bagian JP. Suicide attempts and completions in the emergency department in Veterans Affairs Hospitals. Emerg Med J. Apr 13 2011;[Medline].

  6. Sauvageau A, Ambrosi C, Kelly S. Autoerotic Nonlethal Filmed Hangings: A Case Series and Comments on the Estimation of the Time to Irreversibility in Hanging. Am J Forensic Med Pathol. Jul 20 2011;[Medline].

  7. Nichols SD, McCarthy MC, Ekeh AP, et al. Outcome of cervical near-hanging injuries. J Trauma. Jan 2009;66(1):174-8. [Medline].

  8. Aufderheide TP, Aprahamian C, Mateer JR, et al. Emergency airway management in hanging victims. Ann Emerg Med. Nov 1994;24(5):879-84. [Medline].

  9. Behrendt N, Buhl N, Seidl S. The lethal paraphiliac syndrome: accidental autoerotic deaths in four women and a review of the literature. Int J Legal Med. Jun 2002;116(3):148-52. [Medline].

  10. Centers for Disease Control and Prevention. Suicide trends among youths and young adults aged 10-24 years--United States, 1990-2004. MMWR Morb Mortal Wkly Rep. Sep 7 2007;56(35):905-8. [Medline]. [Full Text].

  11. Fischman CM, Goldstein MS, Gardner LB. Suicidal hanging. An association with the adult respiratory distress syndrome. Chest. Feb 1977;71(2):225-7. [Medline].

  12. Gilbert JA Jr, Gossett CW. Hanging and strangulation injuries. In: The Clinical Practice of Emergency Medicine. 2nd ed. Lippincott Williams & Wilkins; 1996:566.

  13. Iserson KV. Strangulation: a review of ligature, manual, and postural neck compression injuries. Ann Emerg Med. Mar 1984;13(3):179-85. [Medline].

  14. Kleinsasser NH, Priemer FG, Schulze W, et al. External trauma to the larynx: classification, diagnosis, therapy. Eur Arch Otorhinolaryngol. 2000;257(8):439-44. [Medline].

  15. Le D, Macnab AJ. Self strangulation by hanging from cloth towel dispensers in Canadian schools. Inj Prev. Sep 2001;7(3):231-3. [Medline].

  16. McHugh TP, Stout M. Near-hanging injury. Ann Emerg Med. Dec 1983;12(12):774-6. [Medline].

  17. Mohanty MK, Rastogi P, Kumar GP, et al. Periligature injuries in hanging. J Clin Forensic Med. Dec 2003;10(4):255-8. [Medline].

  18. National Safety Council. What are the odds of dying? [e11th-hour.org Web site]. August 15, 2004. Accessed August 1, 2005. [Full Text].

  19. Pesola GR, Westfal RE. Hanging-induced status epilepticus. Am J Emerg Med. Jan 1999;17(1):38-40. [Medline].

  20. Schild JA, Denneny EC. Evaluation and treatment of acute laryngeal fractures. Head Neck. Nov-Dec 1989;11(6):491-6. [Medline].

  21. Seabourne A, Seabourne G. Suicide or accident - self-killing in medieval England: series of 198 cases from the Eyre records. Br J Psychiatry. Jan 2001;178(1):42-7. [Medline].

  22. Shlamovitz GZ, Assia A, Ben-Sira L, et al. "Suffocation roulette": a case of recurrent syncope in an adolescent boy. Ann Emerg Med. Feb 2003;41(2):223-6. [Medline].

  23. US Statistical Abstract of the United States. Government Printing Office; 2003.

 
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