image by:

HWN Suggests

Hanging Injuries

We’ve all certainly been involved with a patient with reported hanging injury at some point in our time in the ED. They are usually unimpressive if a person does it as more of a gesture rather than a true suicide attempt. When they are unfortunately done “correctly,” they usually result in a trip to the morgue instead of the ED. When the swiss cheese holes align and a true hanging attempt results in a serious but not fatal presentation, things can get quite hairy. I’ve been a part of one such case, and will never forget it. Here are my two cents.

read full article

Featured

 Hanging

Every case is different. The patient will require psychiatric evaluation. Be careful of those patients that have had a significant episode, but look well. It may be appropriate to admit overnight and watch primarily for airway swelling.

Articles of Interest

A Child With a Glasgow Coma Scale Score of 4 After Near-Hanging: A Case Report on Treatment Without Intubation and Targeted Temperature Management

While prehospital medical interventions are evolving and improving survival rates, the evidence for adequate early prognostic assessment is often insufficient. A 12-year-old Japanese child was found hanging on the roof of his home. After being rescued by his mother, he was transported by an ambulance and a rapid response car (RRC) with doctors, nurses, and paramedics on board, and admitted to our hospital. His initial Glasgow Coma Scale score in the RRC was 4. Although he did not undergo intubation and targeted temperature management (TTM), he had no neurological sequelae upon discharge

Clinical Focus: Strangulation and Hanging Injuries

The relatively superficial and unprotected jugular veins in the neck are quite vulnerable to compression by external forces. Obstruction of venous outflow from the brain leads to stagnant hypoxia and loss of consciousness in as little as 15 seconds.

Hanging in There. Living beyond Hanging: A Retrospective Review of the Prognostic Factors from a Regional Trauma Center

Independent risk factors for poor outcomes in near-hanging trauma were identified. These factors include relationships between systolic BP, GCS categories, admission vitals, cervical spine injures with fracture, cerebral anoxia, cerebral injury, and pulmonary edema with survival.

Hanging Injuries

High risk of ARDS and cerebral edema so judicious fluids- don’t go flooding them! CT brain (cerrebal hypoxia), CT c-spine (mc= c2 spondylolithesis) and consider CTA head/neck for vascular injury!

Managing the Hanging Injury

Even if the initial presentation is clinically benign, all near-hanging victims and those with vascular compromise should be admitted for 24 hours observation => risk of delayed airway and pulmonary complications.

Non-aneurysmal and non-traumatic subarachnoid hemorrhage after attempted suicide by incomplete hanging

In summary, many patients are admitted to the ED after attempting suicide by hanging, and their symptoms range from mild with an alert state of consciousness to severe with a decreased mental state or even cardiac arrest. Brain imaging, such as a brain CT or MRI, is recommended if the patient’s neurologic symptoms change. This case shows that spontaneous SAH can develop due to a sudden elevation of intracranial pressure, as occurs with hanging.

The Effective Factors on Survival in Near-Hanging

The most important factor in terms of effectiveness over mortality for hanging were observed to be time increment of hanging and low Glasgow coma score. We recommended that the cases of near hanging should be aggressively resuscitated and treated regardless of their bad initial findings.