Treatment for Hanging
The immediate treatment for hanging victims should focus on aggressive resuscitation with airway management as the top priority, regardless of initial poor clinical status, as full recovery is possible with prompt intervention. 1, 2
Initial Assessment and Airway Management
- Ensure a secure airway immediately, as this is the most critical intervention in hanging victims 2
- Perform rapid intubation if the patient is gasping or has poor respiratory effort, as delayed airway management can lead to irreversible brain damage within 3-5 minutes 2, 1
- Cervical spine injuries are rare in non-judicial hanging victims, but external stabilization of the neck should still be performed during airway management 3, 4
- After external stabilization, oral or nasal endotracheal intubation is appropriate for emergency airway management 3
- Monitor for potential soft tissue swelling of the neck that may cause respiratory obstruction 5
Breathing and Circulation Management
- Provide high-quality cardiopulmonary resuscitation if cardiac arrest is present to minimize cerebral anoxia 2
- Administer supplemental oxygen to maintain adequate oxygenation 1
- Monitor closely for the development of pulmonary complications, particularly pulmonary edema and aspiration pneumonia, which are common in hanging victims 4, 1
- For opioid-related hanging attempts, naloxone may be administered at 0.4 mg to 2 mg intravenously, repeated at two to three-minute intervals as needed 6
Neurological Management
- Aggressively treat post-anoxic brain injury even in patients without evident neurologic function in the field, as full recovery may still occur 5
- Initial poor neurological status does not exclude the possibility of good recovery, so aggressive treatment should not be withheld based solely on initial presentation 4, 1
Monitoring and Complications Management
- Continuously observe patients for the first hour after resuscitation 7
- Monitor for development of:
Safety Considerations for Physical Restraint (if needed for agitated survivors)
- Ensure the airway remains unobstructed at all times, especially with prone restraint 7, 8
- With supine restraints, allow the patient's head to rotate freely 7
- Never cover the patient's face with a towel, bag, or other material during therapeutic holding 7
- Avoid putting excess weight on the back of a prone patient 7
- Constantly observe all restrained patients 7
Prognosis
- Aggressive treatment is warranted even in patients with dismal initial presentation, as excellent outcomes are possible despite poor initial condition 1
- All victims with field Glasgow Coma Scale levels >3, and some with GCS = 3, have been shown to survive to discharge with normal mental status 5