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Hanging Injuries and Strangulation Follow-up

  • Author: William Ernoehazy, Jr, MD, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Jan 19, 2016
 

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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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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Inpatient & Outpatient Medications

Phenytoin may help 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

Complications include the following::

  • 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.[12] 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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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

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

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

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

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, Wilderness Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

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.

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