non-fatal suffocation or strangulation

see also:

• domestic violence
• trauma
• https://www.familyjusticecenter.org/wp-content/uploads/2019/04/Recommendations-for-Medical-Radiological-Eval-of-Non-Fatal-Strangulation-v4.9.19.pdf
• 60min Vimeo video training webinar: Insight Exchange Module Strangulation (includes Auslan)
• NSW Govt resource: Managing non-fatal strangulation in the emergency department
• online resources for victims:
  • Queensland Centre for Domestic and Family Violence Research - strangulation fact sheet (pdf)
  • US Family Justice Centre fact sheet (pdf)

• strangulation is the restriction of air caused by something outside the throat whereas choking occurs when something inside the airway causes blockage
• loss of consciousness may occur due to either:
  • carotid artery compression
  • jugular vein compression
  • compression of the airway
• clinical evidence of strangulation includes:
  • clinical signs from the strangulation itself
  • possible clinical signs of defensive injuries if the person was awake and not restrained at the time

• petechiae to head including possibly scalp, eyelids, eyes, face, earlobes and pharynx
• subconjunctival haemorhage
• bruising to mouth or swollen tongue or lips
• trauma to upper airway may be present causing:
  • hoarse voice
  • sore throat
  • stridor
  • dysphagia, drooling
  • cough
• superficial injuries from nails, ligatures, being dragged, etc
• bald spots from hair being pulled back forcibly
• blunt trauma to head from trauma or being forced to the ground
• neurologic signs may be present
  • decreased conscious state or impaired cognition
  • incontinence
  • possible stroke like symptoms or signs
  • ongoing headaches or dizziness

• ABC's as per usual
• protect from perpetrator
• there may need to be mandatory reporting if children are at risk
• CT Angio of carotid/vertebral arteries (and give aspirin 325mg if there will be any delays to CT) if strangulation within past 1 year and any of:
  • evidence for LOC
  • visual changes
  • facial, intra-oral or conjunctival petechial hemorrhage
  • ligature mark or neck contusions
  • soft tissue neck injury/swelling of the neck or carotid tenderness
  • incontinence
  • neurological signs or symptoms
  • dysphonia or aphonia (haematoma, laryngeal fracture, soft tissue swelling, recurrent laryngeal nerve injury)
  • dyspnoea (haematoma, laryngeal fractures, soft tissue swelling, phrenic nerve injury)
  • subcutaneous emphysema (tracheal/laryngeal rupture)
• consider CT brain/neck or MRI brain/neck especially if concern of cerebral ischaemia or cervical injuries
• if no indication for CT angio or the CT angio is normal and neurologically intact then:
  • safe for discharge from a medical aspect if reliable home monitoring for deterioration but may require crisis accommodation, resource information, etc (see domestic violence)
  • advise to return if symptoms worsen or develop SOB, dysphagia or dysphonia