Hanging Injuries and Strangulation Treatment & Management

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

Prehospital Care

  • C-spine stabilization and airway assessment are of paramount importance.
  • Do not attempt endotracheal intubation in the field unless the airway is acutely compromised.
  • If respiratory failure or airway obstruction is present, prehospital intubation of the patient is indicated.
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Emergency Department Care

  • Assessment and treatment of airway status and breathing is paramount. In assessing the patient prior to possible endotracheal intubation, the likelihood of spinal cord injury increases substantially in hanging victims whose drop was equal to or greater than their height, even in incomplete hangings. Fluid resuscitation must be performed judiciously, given the risk of subsequent ARDS and cerebral edema.
  • Monitor the patient for cardiac arrhythmias.
  • Endotracheal intubation may become necessary with very little warning.
  • Cricothyroidotomy is indicated for any patient with airway deterioration, should endotracheal intubation be unsuccessful.
  • If associated neck injuries render cricothyroidotomy difficult, percutaneous translaryngeal ventilation may be used to temporarily oxygenate a patient. Definitive airway management (laryngotomy) must follow swiftly.
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Consultations

  • Consider early consultation with trauma, ENT, trauma, or general surgery for strangulation injuries.
  • Psychiatric consultation should be obtained in cases of suicidal or autoerotic strangulation.
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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

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