Hanging Injuries and Strangulation Workup

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

Laboratory Studies

  • Laboratory tests should not be drawn until after the airway has been assessed and, if necessary, secured.
  • Arterial blood gases (ABGs) analysis should be obtained in all patients who require intubation, for subsequent ventilator management.
  • Given the ready availability of pulse oximetry, ABGs are unnecessary in patients who do not require endotracheal intubation.
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Imaging Studies

  • In nonjudicial hangings, cervical spine injury is rare.
  • Judicial hangings are characterized by drops that are greater than the victim's height. In such drops, the head hyperextends as the noose stops the victim. Classically, the result is bilateral fracture through the pedicles of C2; the body of C2 is displaced anterior to the vertebral body of C3. These hangman fractures are seen best on the lateral radiograph of the cervical spine.
  • Soft-tissue neck radiographs should be obtained in nearly all strangulation victims and patients with a mechanism consistent with hanging. Generally, a fractured hyoid bone indicates a severe, occult soft-tissue injury, even in a patient whose medical condition is otherwise stable. Defer such studies until the airway is secure.
  • Chest radiographs are indicated after endotracheal intubation for placement confirmation and to establish a baseline against which to measure the patient's course. Acute respiratory distress syndrome (ARDS) can occur as a complication of these injuries.
  • CT scanning of the head is indicated when the neurologic status is compromised.
  • CT scanning of the neck provides increased sensitivity for the detection of subtle fractures and other soft-tissue abnormalities. Additionally, clinically subtle injuries to the laryngeal cartilage may not be apparent on plain radiographs.
  • Doppler vascular imaging, CT angiography, or arteriography of the carotids should be considered in cases of garroting. The thin wires or cords used in these assaults often produce deep vascular thrombosis. MRI may be a reasonable choice in centers where it is readily available.
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Procedures

  • In patients who are not at immediate risk of airway compromise, direct fiberoptic laryngoscopy and microlaryngoscopy may play a role in establishing the full pattern of injuries. An ENT consultation can establish both the need for, and the timing of, these studies.
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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.

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