What is the management approach for a patient who has been rescued from hanging?

Management of Patients Rescued from Hanging

Patients rescued from hanging should receive immediate and aggressive resuscitation regardless of their initial presentation, as early intervention can significantly improve outcomes and save lives. 1, 2

Initial Assessment and Resuscitation

1. Scene Safety and Initial Evaluation

   • Ensure scene safety before approaching the patient
   • Check responsiveness by tapping the shoulder and shouting "Are you all right?"
   • Simultaneously check breathing and pulse (taking no more than 10 seconds) 1
   • Immediately activate emergency response system (call 911)

2. For Unresponsive Patients Not Breathing Normally

   • Begin CPR immediately starting with chest compressions
   • Follow 30:2 compression-to-ventilation ratio
   • Perform high-quality chest compressions:
     • Rate: 100-120 compressions per minute
     • Depth: At least 2 inches (5 cm)
     • Allow complete chest recoil between compressions
     • Minimize interruptions in compressions 1

3. Airway Management

   • Use head tilt/chin lift maneuver to open airway (unless cervical spine injury is suspected)
   • Remove any visible obstructions from the mouth
   • If advanced airway is placed, provide 1 breath every 6 seconds (10 breaths/minute) with continuous chest compressions 1
   • For untrained rescuers: hands-only CPR is acceptable

Specific Management Considerations

1. Cervical Spine Protection

   • While cervical spine injuries are uncommon in hanging victims, maintain cervical spine precautions until injury is ruled out 3, 4
   • Avoid excessive manipulation of the neck during resuscitation

2. Airway and Breathing

   • Early intubation may be necessary for airway protection and ventilatory support 2
   • Monitor for delayed respiratory complications including:
     • Pulmonary edema
     • Aspiration pneumonia
     • Airway edema 2, 3

3. Circulatory Assessment

   • Assess for carotid artery injuries, which may require surgical intervention in severe cases 4
   • Monitor for cardiac arrhythmias and hemodynamic instability
   • Provide fluid resuscitation as needed

4. Neurological Evaluation

   • Perform detailed neurological assessment once patient is stabilized
   • Even patients with severe initial neurological deficits may recover with aggressive care 2, 5
   • Monitor for cerebral edema and increased intracranial pressure

Hospital Management

1. Intensive Care Admission

   • All patients rescued from hanging should be admitted to an intensive care unit for close monitoring, even if they appear to recover quickly 1, 2
   • Continuous cardiac and neurological monitoring is essential

2. Diagnostic Imaging

   • CT scan of head and neck to evaluate for:
     • Cerebral edema/hypoxic brain injury
     • Vascular injuries (especially carotid arteries)
     • Laryngeal/tracheal trauma
     • Cervical spine injuries 3, 4

3. Psychiatric Evaluation

   • Arrange for psychiatric assessment once medically stable, as hanging is commonly associated with suicide attempts 5

Important Caveats and Pitfalls

• Do not delay resuscitation even in patients with dismal initial presentation, as good outcomes are possible with aggressive care 2, 5
• Beware of agonal gasps which can be misinterpreted as normal breathing, leading to delayed CPR 1
• Avoid unnecessary movement of the patient unless in immediate danger 1
• Watch for delayed complications including respiratory failure, pulmonary edema, and neurological deterioration 3
• Never assume poor prognosis based on initial presentation alone, as many patients can make full neurological recovery with proper care 2, 5