What is the acute treatment for hanging?

Acute Treatment for Hanging

The immediate priority in hanging victims is to secure the airway, provide ventilation if needed, and support circulation through high-quality CPR if cardiac arrest has occurred, while maintaining cervical spine stabilization. 1, 2

Initial Assessment and Management

• Immediately remove the ligature while supporting the neck to prevent further injury 2, 3
• Establish and maintain an open airway as the first priority 4, 5
• Assess breathing and circulation following the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) 6, 7
• If breathing is inadequate, provide bag-mask ventilation followed by endotracheal intubation when appropriate 4, 5
• For patients in cardiac arrest, begin high-quality CPR immediately at a rate of 100-120 compressions per minute with minimal interruptions 1, 8

Airway Management

• Lift the jaw and insert an oropharyngeal airway to prevent tongue obstruction in unconscious patients 5, 6
• Following external stabilization of the neck, oral or nasal endotracheal intubation is appropriate emergency airway management in hanging victims 3, 7
• If intubation is difficult, consider supraglottic devices as they are easier and safer to handle 5, 6
• In cases where airway access is extremely difficult, consider emergency tracheotomy or transtracheal puncture techniques, but only if performed by trained personnel 5

Circulation Support

• Establish intravenous access for medication administration 1, 8
• For patients in cardiac arrest, administer epinephrine 1 mg IV every 3-5 minutes 1, 8
• Reassess rhythm after 2 minutes of CPR 1
• If ventricular fibrillation or pulseless ventricular tachycardia is present, deliver shock according to standard defibrillation protocols 1

Additional Considerations

• Assess for and treat potential hypoxia, which is the primary cause of injury in hanging victims 1, 3
• Monitor for aspiration pneumonia, which can be a complication in hanging victims 2
• Evaluate for potential reversible causes of cardiac arrest using the 5 H's and 4 T's framework (Hypovolemia, Hypoxia, Hydrogen ion/acidosis, Hypo/hyperkalemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis) 1
• Consider the possibility of multiple drug ingestion if the hanging was a suicide attempt 4

Important Clinical Considerations

• Cerebral hypoxia rather than spinal cord injury is the probable cause of death in hanging victims and should be the primary concern in treatment 3, 7
• Despite the common belief, cervical spine injury is rare in non-judicial hanging victims, but cervical spine stabilization should still be maintained during resuscitation 3
• Cases of near-hanging should be aggressively resuscitated regardless of poor initial presentation, as good outcomes are possible with prompt intervention 2
• Hypoxia from obstructed airways can become life-threatening within 5-6 minutes, potentially causing cerebral ischemia and cardiac arrest 5, 7