strangulation

non-fatal suffocation or strangulation

Introduction

  • 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

clinical signs from the strangulation

  • 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

ED Mx

  • ABC's as per usual
  • protect from perpetrator
  • 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
strangulation.txt · Last modified: 2019/08/12 03:11 by wh