Hanging Injuries and Strangulation Treatment & Management

Updated: Dec 03, 2020
  • Author: Scott I Goldstein, DO, FACEP, EMT-T/PHP; Chief Editor: Trevor John Mills, MD, MPH  more...
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Emergency Department 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. 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. [8, 33]

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.

A cervical collar or other immobilization device should be immediately applied In any patients who have extensive cervical injury findings.