What is the treatment for hanging injuries?

Treatment of Hanging Injuries

Aggressive resuscitation and intensive care management are essential for hanging injuries regardless of initial presentation, as full recovery is possible even in patients with poor initial condition. 1, 2, 3

Initial Assessment and Management

Immediate Priorities

• Ensure scene safety by turning off power source if electrocution is involved 4
• Assess for cardiac arrest (most common immediate cause of death) 4
• Check for respiratory arrest (may result from respiratory center injury or muscle paralysis) 4
• Begin CPR immediately if needed, using standard ACLS protocols 4

Airway Management

• Immediate intubation for patients with:
  • Respiratory distress
  • Decreased level of consciousness (GCS < 15)
  • Signs of airway compromise (stridor, voice changes, difficulty breathing) 5, 1
• Monitor for soft tissue swelling that may cause respiratory obstruction 3

Diagnostic Evaluation

Clinical Assessment

• Evaluate neurological status using Glasgow Coma Scale (GCS)
• Examine for signs of trauma to the neck:
  • Cervical spine tenderness
  • Dysphagia, dysphonia, stridor, or crepitus 6

Imaging

• Patients with normal GCS (15) AND no cervical spine tenderness or other signs (dysphagia, dysphonia, stridor, crepitus) require minimal imaging 6
• For patients with abnormal GCS (<15) OR positive signs/symptoms:
  • CT scan of head and neck
  • Consider MRI if neurological deficits are present 6

Treatment Protocol

Resuscitation Phase

• Provide oxygen supplementation
• Secure IV access for fluid resuscitation
• Continuous cardiac monitoring for arrhythmias 4
• Treat shock if present according to standard protocols 5

Critical Care Management

• Ventilatory support for respiratory failure
• Monitor for and treat complications:
  • Pulmonary edema/ARDS (occurs in some patients) 3
  • Aspiration pneumonia 1
  • Post-anoxic brain injury
  • Compartment syndrome in extremities 4

Specific Considerations

• Cervical spine fractures are rare in hanging injuries without significant drops (>5 feet) 3, 6
• Mechanism of injury is primarily ligature strangulation rather than cervical spinal cord injury 2
• Treat any associated thermal burns per burn protocols if electrocution was involved 4

Prognostic Factors

• Initial GCS does not reliably predict outcome - patients with GCS as low as 3 can recover fully 3
• Presence of bystander CPR significantly improves chances of ROSC and survival 7
• Aggressive treatment is warranted even in patients with poor initial presentation 1, 2

Follow-up Care

• Neurological assessment for potential hypoxic brain injury
• Psychiatric evaluation and intervention for attempted suicides 5
• Rehabilitation for any residual deficits

Important Caveats

• Do not withhold aggressive treatment based on poor initial presentation alone 1, 2
• Initial presenting features correlate poorly with eventual outcome 2
• Patients with normal GCS, no cervical spine tenderness, and no other signs/symptoms have extremely low risk of significant injury 6
• Pediatric hanging victims require the same aggressive approach as adults, though outcomes are generally poor with survivors likely to suffer neurological injury 7