Strangling

Strangling is a form of violent asphyxiation that involves the compression of blood vessels and air passages in the neck due to external pressure. It can lead to severe injury or death and is often associated with instances of homicide, suicide, and assault.

Types of Strangulation

Strangulation can be classified into various types based on the method of compression used:

Manual Strangulation

This form of strangulation involves the use of hands, forearms, or other limbs to apply pressure on the neck. It's commonly associated with instances of domestic violence and physical assaults.

Ligature Strangulation

Ligature strangulation involves the use of a cord-like object, such as a rope, wire, or scarf, wrapped around the neck to apply pressure. This method is often associated with suicides and homicides.

Hanging

While technically a form of ligature strangulation, hanging is typically classified separately due to the unique dynamics involved. In this method, the pressure on the neck is generated by the person's own body weight.

Physiological Effects

The act of strangulation impedes the flow of oxygen and blood to the brain, which can lead to unconsciousness within seconds and death within minutes. The pressure on the neck can also damage the trachea, larynx, and blood vessels, leading to long-term health complications in survivors.

Legal Considerations

Strangulation is considered a serious crime in many jurisdictions, often classified as attempted murder, aggravated assault, or a similar violent crime. In recent years, some jurisdictions have begun to classify non-fatal strangulation as a distinct and serious crime due to its frequent occurrence in cases of domestic violence.

Prevention and Response

Education and awareness are crucial in the prevention of strangulation injuries and fatalities. It is important for individuals, particularly those in professions such as healthcare, education, and law enforcement, to be aware of the signs and symptoms of strangulation, which can often be non-visible and easily overlooked.

Immediate medical attention is required for anyone who has been strangled, due to the risk of serious internal injuries and delayed complications such as stroke and pulmonary edema.

Medical Management

Given the potential for serious and potentially delayed complications, immediate medical evaluation is critical following a strangulation event. This may involve: Airway management: Assessment and stabilization of the patient's airway is paramount. In severe cases, this might involve intubation

• or emergency tracheotomy.
• Imaging: Depending on the patient's symptoms and the nature of the strangulation event, imaging studies like X-ray, CT scan, or MRI can be helpful in evaluating the extent of injury to the neck structures.
• Observation: Even in patients who appear asymptomatic or minimally symptomatic initially, observation for a period of time in a medical setting is generally recommended due to the risk of delayed complications such as airway swelling or cerebral ischemia.

Prognosis

The prognosis following strangulation varies widely, depending largely on the duration and intensity of the strangulation event and the timeliness of medical intervention. Some individuals may fully recover with appropriate medical care, while others may suffer long-term complications such as voice changes, difficulty swallowing, or neurological issues. In severe cases, strangulation can lead to death.

Awareness and Training

Given the prevalence of strangulation particularly in instances of domestic violence, many organizations advocate for increased awareness and training among medical and legal professionals, as well as the public. This includes recognition of signs and symptoms that might suggest a history of strangulation, even in the absence of visible external injuries.

See Also

• Choking
• Asphyxia
• Homicide

References

• Heide, S., & Solomon, E. P. (2006). Biology, diagnosis and treatment of non-fatal strangulation in abusive head trauma: a review of the literature. Trauma, Violence, & Abuse, 7(3), 195-205.
• Hawley, D., McClane, G. E., & Strack, G. B. (2001). A review of 300 attempted strangulation cases Part IV: Special cases. The Journal of Emergency Medicine, 21(3), 355-362.
• Jones, J. H., Murphy, M. P., & Mintegi, S. (2014). The recognition and documentation of strangulation forensic markers in the pediatric emergency setting. Pediatric Emergency Care, 30(10), 723-727.
• Strack GB, McClane GE, Hawley D. (2001). A review of 300 attempted strangulation cases Part I: Criminal legal issues. The Journal of Emergency Medicine, 21(3), 303-309.
• Strack GB, McClane GE, Hawley D. (2001). A review of 300 attempted strangulation cases Part II: Clinical evaluation of the surviving victim. The Journal of Emergency Medicine, 21(3), 311-315.
• McClane GE, Strack GB, Hawley D. (2001). A review of 300 attempted strangulation cases Part III: Injuries in fatal cases. The Journal of Emergency Medicine, 21(3), 317-322.

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