The emergency department management of near-hanging victims

Krol, Laurie Vande; Wolfe, Richard

doi:10.1016/0736-4679(94)90268-2

Cited by 63 publications

(31 citation statements)

References 49 publications

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“…A different mechanism of injury occurs in judicial hangings, where the length of drop is typically equivalent to the victim's height, and where suspension is always complete. In non-judicial hanging, there is often no significant drop, 14 and suspension is often incomplete. 3 This means that the axial traction component of the hanging injury is far less, and this difference probably explains the much lower incidence of cord injury.…”

Section: Cervical Spine Injurymentioning

confidence: 99%

“…Irreversible brain damage occurs within 5-6 min of complete cessation of cerebral blood flow, whereas hanging suspension times of up to 30 min with complete recovery of neurologic function have been documented. 14 The cerebral hypoxic injury is not always evenly distributed, due to variation in both the sensitivity of various brain tissues to hypoxia, and local variations in blood flow. Transient hemiparesis, 14 and cerebral infarction 11 after near hanging injury have been noted in a few cases.…”

Section: Secondary Cerebral Injurymentioning

confidence: 99%

“…14 The cerebral hypoxic injury is not always evenly distributed, due to variation in both the sensitivity of various brain tissues to hypoxia, and local variations in blood flow. Transient hemiparesis, 14 and cerebral infarction 11 after near hanging injury have been noted in a few cases. Focal cerebral deficits may also occur, due to arterial dissection or spasm, or subarachnoid haemorrhage.…”

Section: Secondary Cerebral Injurymentioning

confidence: 99%

“…Some authors recommend that precautions be taken to protect the cervical spine, 17,21 while others do not. 1,8,14,22 Although the incidence of cervical spine injury is very low among patients who have not sustained a significant drop, and who do not have pre-existing cervical spine disease, accurate information about these risk factors is usually not available in the emergency situation. It may be prudent to treat all near hanging victims in the same way as other trauma patients, by assuming that they have an unstable cervical spine until proven otherwise.…”

Section: Managementmentioning

confidence: 99%

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Near hanging

Adams

1999

Emergency Medicine

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Objectives: To review the literature on near hanging, focusing on the pathophysiology, and relating this to the clinical features and management. Methods: English language articles published in the past 15 years and major textbooks of emergency and forensic medicine were searched. Eight case series and six relevant single case reports were identified. Only articles concerned with non‐judicial near hanging were reviewed. Data concerning the incidence of cervical spine injury, laryngeal injury, pulmonary complications and mortality were extracted. Not the case series documented the presence or absence of all these factors, resulting in differing total patient numbers in each category. Unusual complications of near hanging were documented from case reports. Results: Cervical spine injury occurred in four of 689 patients (0.6%). Pulmonary complications occurred in 15 of 133 patients (11%). The in‐hospital mortality rate was 23% (29 deaths of 128). No clinically significant laryngeal injuries were reported. Unusual complications documented included hyperthermia, status epilepticus, carotid artery dissection, subarachnoid haemorrhage and pneumoperitoneum. Conclusions: Cervical spine injury, although uncommon, does occur in near hanging, and emergent airway management should take this into account. Laryngeal injury sufficiently severe to interfere with endotracheal intubation does not appear to occur. Cerebral oedema, aspiration pneumonia and acute respiratory distress syndrome are the commonest in‐hospital complications. Management of near hanging involves establishment of a safe airway, plus treatment of pulmonary and cerebral oedema along standard lines. In‐hospital mortality remains high.

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Section: Cervical Spine Injurymentioning

confidence: 99%

Section: Secondary Cerebral Injurymentioning

confidence: 99%

Section: Secondary Cerebral Injurymentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

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Near hanging

Adams

1999

Emergency Medicine

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“…5 Cervical spine injury usually is not found to be associated with suicidal hanging as opposed to judicial hanging where body falls from height more than the actual height of the victim. 10 The pathophysiological basis of adverse outcome in hanging has been attributed to various factors like cerebral hypoxia, laryngeal oedema, airway obstruction, high vagal tone secondary to carotid sinus stimulation injuries secondary to local structures like thyroid cartilage/hyoid bone fracture/laryngeal rupture, secondary pulmonary complications (aspiration pneumonia, development of adult respiratory distress, negative pressure, pulmonary oedema or secondary cerebral injury due to cerebral oedema etc. 6,7 As in every other study, majority of patients who attempt suicidal hanging are invariably male and young, the same pattern continues in our study also.…”

Section: Discussionmentioning

confidence: 99%

Can clinical variables at admission influence the outcome in patients with suicidal hanging: a prospective study

Raajesh

Shanmugam

2016

Int J Adv Med

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INTRODUCTIONThere is worldwide concern over an observed rise in the rate of suicide, especially among young adults. [1][2][3] Hanging is considered one of the commonest way of committing suicide next only to poisoning in India. 4 Hanging victims present to emergency department of hospitals and most of them need specialized care in intensive care units. Unfortunately, suicidal hanging is one medical emergency about which there is very little information available in medical literature. Though numbers of reports about post-mortem findings in nearhanging are available, published data on clinical aspects of the problem and means of prognostication to guide the clinician are scanty. Also there are only very few studies available relating the risk factors with the outcome of suicidal-hanging patients. ABSTRACT Background:Hanging is considered one of the commonest ways of committing suicide, next only to poisoning in India. Very little information is only available in medical literature about prognosticating factors in suicidal hanging. Analysis of various parameters at the time of admission and their association with outcome can help in risk stratification as well as prognostication. Methods: Four variables namely GCS, Mean arterial pressure, Oxygen saturation and capillary blood sugar were recorded at the time of admission. All patients received standard intensive care throughout the stay in ICU as demanded. Outcome was divided in to two groups, Good and poor. Good outcome was defined as complete neurological recovery at the time of discharge and poor outcome was defined as either death during hospital stay or persistent neurological deficit which did not improve even after a period of three months follow up. Results: Total of forty patients was included in the study. Male patients outnumbered the number of female patients admitted with suicidal hanging. Irrespective of the gender more patients belonged to the third decade of. Out of forty, thirty patients showed complete neurological recovery, five patients had persistent neurological deficit even after three months and five patients died during the course of the treatment. Conclusions: The present study confirms the age and sex distribution of suicidal hanging which is more common amongst male gender and 3rd followed by 4th decade of life in both sex. Admission parameters like GCS≤8, MAP < 60 mmHg and CBG >180mg % can be considered as risk factors for poor outcome.

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