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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.


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.


Inpatient & Outpatient Medications

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



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



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.



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.
Contributor Information and Disclosures

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.


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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