Official websites use. Share sensitive information only on official, secure websites. Email: riviellor uthscsa. Patients with a history of strangulation present to the emergency department with a variety of different circumstances and injury patterns. We review the terminology, pathophysiology, evaluation, management, and special considerations for strangulation injuries, including an overview of forensic considerations and legal framework for strangulation events.
Keywords: airway, asphyxiation, carotid, choking, emergency medicine, strangulation. Patients present to the emergency department ED for evaluation after strangulation, and the contexts and resulting injury patterns can vary widely. Emergency clinicians should be familiar with the terminology describing these events, the pathophysiology behind the potential injuries, the signs and symptoms that can be present, the suggested management, and some of the special circumstances of occurrence.
Neck compression incidents are common, and the injuries can be serious. Many terms describe forceful neck compression. Strangulation involves pressure applied to the neck resulting in compression. Neck structures do not all compress with similar force. The jugular veins compress with less pressure than the carotid arteries because of malleable vessel walls and lower intravascular pressure. Hence, vascular compression is the primary mechanism responsible for altering blood flow to and from the brain.
Ischemic injuries can occur directly from lack of blood flow from compression, clot formation, or arterial dissection. Hypoxic injuries can occur from airway damage or secondary pulmonary effects.
Autoregulation of brain microvasculature allows for adequate blood flow at a CPP as low as 50 mmHg; loss of consciousness LOC is more likely below this level. LOC after fully established manual 12 , 17 , 18 , 19 , 20 , 21 or machine 15 , 17 compression in volunteers typically occurs in 6β14 seconds; this time frame has been verified in fully resisting combatants as well. Although pressure on the carotid body can reduce heart rate and blood pressure via vagal stimulation, this is rarely the cause of CPP reduction during strangulation.
