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Neck Injury by Strangulation/Hanging, Emergency Medicine

David Della- Giustina and Karen Della- Giustina Reviewed 06/2017



  • Strangulation:

    • Ligature: Material used to compress structures of neck

    • Manual: Physical force used to compress structures of neck

    • Postural: Airway obstruction from body weight (over an o...


Signs and Symptoms

  • Airway disruption:

    • SC emphysema

    • Dyspnea

    • Dysphonia or stridor

    • Loss of normal cartilaginous landmarks

  • Cervical spine injury:

    • Respiratory arrest

    • Paralysis

  • Neurologic injury:

    • Hoarseness

    • ...



  • ABCs

  • Early and aggressive airway management: Oxygen, suction, intubation, as indicated:

    • Remove ligature.

  • Cardiac monitor

  • Cervical spine stabilization:

    • Patient position, strangulation ...



Admission Criteria

  • Admit patients with strangulation or hanging-mechanism injuries to a monitored setting to observe for airway or neurologic compromise (may have delayed onset).

  • Su...

Pearls and Pitfalls

  • Cervical spine injury is uncommon in nonjudicial hanging victims:

    • Cerebral hypoxia is the probable cause of death in the majority of victims.

  • Aggressive airway management is paramoun...

Additional Reading

  • Christe  A, Oesterhelweg  L, Ross  S, et al. Can MRI of the neck compete with clinical findings in assessing danger to life for survivors of manual strangulation? A statistical anal...



994.7 Asphyxiation and strangulation 


  • T71.161A Asphyxiation due to hanging, accidental, initial encounter

  • T71.162A Asphyxiation due to hanging, intentional self-harm, initial encounter

  • T71...

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