Hanging Injuries and Strangulation Workup

Updated: Dec 03, 2018
  • Author: William S Ernoehazy, Jr, MD, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
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Approach Considerations

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.

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.


Imaging Studies

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.

In nonjudicial hangings, cervical spine injury is rare. However, laryngeal injuries can result. [14]  Traumatic vascular thrombosis can occur as a result of the pressures placed on the vascular structures by the ligature. Such injuries can also be caused by garroting.

Given these varied injuries and the superiority of CT over plain films in the evaluation of the cervical spine,  [15]  early CT imaging and CT angiography should be obtained in any symptomatic hanging survivor. If there is any neurologic abnormality on initial assessment, CT imaging of the head is also indicated. MRI may have a role in further defining injuries found at initial imaging.

As always, 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.