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

Management of Hanging

Immediately prioritize airway management and aggressive resuscitation regardless of initial clinical presentation, as early intervention can achieve full neurological recovery even in patients presenting with poor clinical status. 1

Initial Scene Safety and Assessment

• Ensure scene safety for rescuers before approaching the victim, as danger to the rescuer must never be ignored 2
• Rapidly cut down or remove the victim from the hanging position using the fastest means available 2
• Cervical spine immobilization is NOT routinely recommended unless there are specific circumstances suggesting spinal injury (alcohol intoxication, diving into shallow water, or obvious signs of trauma), as routine stabilization can impede airway opening and delay rescue breathing 2

Immediate Resuscitation (A-B-C Sequence)

For hanging victims, use the traditional A-B-C approach rather than C-A-B, as this is a hypoxic arrest requiring immediate oxygenation. 2

Airway Management

• Check responsiveness by gently shaking shoulders and asking loudly "Are you all right?" 2
• If unresponsive, open the airway using head tilt-chin lift maneuver: place hand on forehead and tilt head back while lifting chin with fingertips 2
• Remove any visible obstruction from the mouth, including dislodged dentures (leave well-fitting dentures in place) 2
• Intubation has a 100% success rate when performed by experienced teams despite concerns about laryngeal injury or airway edema 3

Breathing Assessment and Support

• Look, listen, and feel for breathing for 10 seconds: look for chest movements, listen for breath sounds at the mouth, feel for air on your cheek 2
• Treat occasional gasps as absent breathing—gasps do not provide adequate ventilation 2
• If not breathing, give 2 effective rescue breaths (1.5-2 seconds each, 400-600 ml air) that make the chest rise and fall 2
• If difficulty achieving effective breaths, recheck mouth for obstruction and ensure adequate head tilt/chin lift; make up to 5 attempts to achieve 2 effective breaths 2

Circulation Assessment

• Assess for signs of circulation: look for any movement, swallowing, or breathing; check carotid pulse 2
• Take no more than 10 seconds to check for pulse—if not definitely felt, start chest compressions immediately 2

CPR Protocol

If Circulation Present but Not Breathing

• Continue rescue breathing at approximately 10 breaths per minute 2
• Recheck for signs of circulation every minute (no more than 10 seconds each time) 2
• If victim starts breathing but remains unconscious, place in recovery position 2

If No Circulation or Uncertain

• Begin chest compressions immediately 2
• Locate lower half of sternum: identify lower rib margin, slide fingers upward to where ribs join sternum, place heel of hand on middle of lower half of sternum 2
• Compress at least 2 inches (5 cm) deep at rate of 100 compressions per minute 2
• Use 15:2 compression-to-ventilation ratio for single rescuer 2
• Allow complete chest recoil between compressions—incomplete recoil decreases coronary perfusion and cerebral blood flow 2

Hospital Management

Airway and Ventilation

• Intubate immediately if patient is gasping or has poor clinical status 1
• Provide assisted ventilation and intensive care treatment 1
• Monitor for post-obstructive pulmonary edema, which can develop after removal of upper airway obstruction and is a fatal complication 4

Supportive Care

• Provide standard intensive care support regardless of initial dismal presentation 1
• Monitor for aspiration pneumonia, which can complicate recovery 1
• Case fatality for hanging is approximately 70%, but 80-90% of those reaching hospital alive survive 5

Critical Pitfalls to Avoid

• Do NOT delay resuscitation to assess for cervical spine injury unless specific trauma indicators are present 2
• Do NOT use abdominal thrusts or Heimlich maneuver—these are not indicated for hanging victims and can cause injury, vomiting, and aspiration 2
• Do NOT assume poor prognosis based on initial presentation—aggressive treatment can result in full neurological recovery without deficit 1
• Do NOT mistake occasional gasps for adequate breathing 2
• Do NOT take more than 10 seconds to check pulse before initiating compressions 2