Strangulation: Difference between revisions
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**Hanging, ligature, manual or postural strangulation | **Hanging, ligature, manual or postural strangulation | ||
**Homicide, assault, suicide or execution | **Homicide, assault, suicide or execution | ||
*Mechanism of death/injury | *Mechanism of death/injury <ref>Iserson, K. V. (1984) ‘Strangulation: A review of ligature, manual, and postural neck compression injuries’, Annals of Emergency Medicine, 13(3), pp. 179–185.</ref> | ||
**Spinal cord/brainstem injury | **Spinal cord/brainstem injury | ||
**Mechanical compression | **Mechanical compression | ||
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**[[Neurogenic shock]] | **[[Neurogenic shock]] | ||
**Cerebral anoxia | **Cerebral anoxia | ||
**Cerebral edema | |||
**Delayed dementia, amnesia, psychosis | **Delayed dementia, amnesia, psychosis | ||
| Line 45: | Line 46: | ||
*Chem 10 | *Chem 10 | ||
*PT/PTT | *PT/PTT | ||
*Type and screen | |||
*Lactate | *Lactate | ||
*VBG/ABG | *VBG/ABG | ||
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*CTA neck | *CTA neck | ||
*CXR | *CXR | ||
==Treatment== | |||
*[[ATLS]] | |||
*Secure airway if indicated | |||
**Stridor/hoarseness suggests upper airway obstruction | |||
*Cervical spine immobilization | |||
*Cardiac monitoring | |||
*ABX if aspiration present | |||
*PEEP for hypoxia | |||
*Levophed for neurogenic shock | |||
==Disposition== | |||
*Observation warranted if awake, alert, no stridor | |||
*ICU | |||
Revision as of 02:10, 13 June 2015
Background
- Strangulation
- Hanging, ligature, manual or postural strangulation
- Homicide, assault, suicide or execution
- Mechanism of death/injury [1]
- Spinal cord/brainstem injury
- Mechanical compression
- Bradycardia
Pathophysiology
- Upper C-spine fractures
- Hanging, greater heights
- Jugular venous obstruction
- Cerebral congestion
- Loss of consciousness
- Arterial compression
- Cerebral ischemia
- Airway compression
- Hypoxia
- Carotid baroreceptor reflex
- Bradycardic arrest
Clinical Features
- Facial petechiae
- Ecchymoses
- Airway
- Hoarseness
- Stridor
- Fracture of larynx, hyoid, thyroid cartilage
- Laryngeal edema
- Cardiopulmonary
- Aspiration pneumonia
- Cardiac arrest
- Bradycardia
- Neurogenic pulmonary edema
- Neurologic
- Spinal cord trauma
- Hangman's fracture uncommon
- Neurogenic shock
- Cerebral anoxia
- Cerebral edema
- Delayed dementia, amnesia, psychosis
Work up
- CBC
- Chem 10
- PT/PTT
- Type and screen
- Lactate
- VBG/ABG
- EtOH, UTox
- CT brain
- CT cervical spine
- CTA neck
- CXR
Treatment
- ATLS
- Secure airway if indicated
- Stridor/hoarseness suggests upper airway obstruction
- Cervical spine immobilization
- Cardiac monitoring
- ABX if aspiration present
- PEEP for hypoxia
- Levophed for neurogenic shock
Disposition
- Observation warranted if awake, alert, no stridor
- ICU
- ↑ Iserson, K. V. (1984) ‘Strangulation: A review of ligature, manual, and postural neck compression injuries’, Annals of Emergency Medicine, 13(3), pp. 179–185.