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Pigolkin YI, Zhandarov KA, Gornostaev DV, Yagmurov OD, Sheptulin DA. [Dissection technique for organs of the neck in hanging]. Sud Med Ekspert 2023; 66:52-55. [PMID: 37192460 DOI: 10.17116/sudmed20236603152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The aim of this study is to develop a comprehensive dissection technique to examine the deep structures of the neck in hanging, including extraction of the cervical spine and investigation of the removed segment with access to vertebral arteries and spinal cord. Its advantages include the unnecessity of any special instruments usage, the short period of time, which is necessary for performing dissection techniques, as well as the possible detailed examination of the spine, spinal cord and vertebral arteries. The improved dissection technique simplifies the diagnosis of injuries and increases the objectivity of the forensic medical examination in hanging.
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Affiliation(s)
- Yu I Pigolkin
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - K A Zhandarov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - D V Gornostaev
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Bureau of Forensic Medical Expertise, Moscow, Russia
| | - O D Yagmurov
- Bureau of Forensic Medical Expertise, St. Petersburg, Russia
| | - D A Sheptulin
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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2
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Turner J, Brown A, Boldy R, Lumley-Holmes J, Rosser A, James A. Out-of-hospital cardiac arrest due to hanging: a retrospective analysis. Emerg Med J 2021; 39:106-110. [PMID: 33931431 DOI: 10.1136/emermed-2020-210839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND There has been little research into the prehospital management of cardiac arrest following hanging despite it being among the most prevalent methods of suicide worldwide. The aim of this study was to report the characteristics, resuscitative treatment and outcomes of patients managed in the prehospital environment for cardiac arrest secondary to hanging and compare these with all-cause out-of-hospital cardiac arrest (OHCA). METHODS Data from a UK ambulance service cardiac arrest registry were extracted for all cases in which treatment was provided for OHCA due to hanging between 1 January 2013 and 30 June 2018. Cases were linked to outcome data obtained from the Trauma Audit and Research Network. Comparison of the cohort was made to previously published data from a UK study of all-cause OHCA with 95% CIs calculated for the proportional difference between the studies in selected presentation and outcome variables. RESULTS 189 cases were identified. 95 patients were conveyed to hospital and four of these survived to discharge. 40 patients were conveyed despite absence of a spontaneous circulation and none of these patients survived. While only three patients were initially in a shockable rhythm, DC shocks were administered in 20 cases. There was one case of failed ventilation prompting front-of-neck access for oxygenation. By comparison with all-cause OHCA the proportion of patients with a spontaneous circulation at hospital handover was similar (27.0% vs 27.5%; 0.5% difference, 95% CI -5.9% to 6.8%, p=0.882) but survival to hospital discharge was significantly lower (2.2% vs 8.4%; 6.2% difference, 95% CI 4.1% to 8.3%, p=0.002). CONCLUSION Clinical outcomes following OHCA due to hanging are poor, particularly when patients are transported while in cardiac arrest. Failure to ventilate was uncommon, and clinicians should be alert to the possibility of shockable rhythms developing during resuscitation.
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Affiliation(s)
- Jake Turner
- Anaesthetic Department, Nottingham University Hospitals NHS Trust, Nottingham, UK .,Midlands Air Ambulance, Midlands Air Ambulance Charity, Stourbridge, UK.,West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - Aidan Brown
- Midlands Air Ambulance, Midlands Air Ambulance Charity, Stourbridge, UK.,West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - Rhiannon Boldy
- West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | | | - Andy Rosser
- West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - Alex James
- Midlands Air Ambulance, Midlands Air Ambulance Charity, Stourbridge, UK.,West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK.,Anaesthetic Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.,School Medicine, University of Keele, Newcastle-under-Lyme, Staffordshire, UK
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3
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Boots RJ, Joyce C, Mullany DV, Anstey C, Blackwell N, Garrett PM, Gillis S, Alexander N. Near-Hanging as Presenting to Hospitals in Queensland: Recommendations for Practice. Anaesth Intensive Care 2019; 34:736-45. [PMID: 17183891 DOI: 10.1177/0310057x0603400610] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Near-hanging is an increasing presentation to hospitals in Australasia. We reviewed the clinical management and outcome of these patients as they presented to public hospitals in Queensland. A retrospective clinical record audit was made at five public hospitals between 1991 and 2000. Of 161 patients enrolled, 82% were male, 8% were indigenous and 10% had made a previous hanging attempt. Chronic medical illnesses were documented in 11% and previous psychiatric disorders in 42%. Of the 38 patients with a Glasgow Coma Scale score (GCS) of 3 on arrival at hospital, 32% returned to independent living and 63% died. Fifty-two patients received CPR, of whom 46% had an independent functional outcome. Independent predictors of mortality were a GCS on hospital arrival of 3 (AOR 150, CI 95% 12.4–1818, P<0.001), taking plain X-rays of the cervical spine (AOR 0.06, CI 95% 0.004–0.97, P=0.047) and contact with the ground (AOR 0.03, CI 95% 0.002–0.62, P=0.02). Only 66% had imaging of the cervical spine performed with other imaging performed infrequently. There were three laryngeal, two hyoid bone and three cervical spine injuries and one carotid dissection. The number of cervical spine X-rays required to find a significant cervical spine fracture was 54. Near-hanging presenting to hospital with a poor conscious state or even cardiac arrest can have a favourable clinical outcome. Radiological investigations are infrequently performed despite a low GCS precluding early accurate assessment. Given the general favourable outcome, an aggressive approach to searching for correctable injuries is recommended.
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Affiliation(s)
- R J Boots
- Department of Intensive Care, Royal Brisbane and Women's Hospital, Brisbane
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4
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Lee Y, Ahn H, Sohn Y, Ahn J, Park S, Hong C, Hwang S, Na J, Shin D, Jo I, Song K, Sim M. Clinical Experience of Therapeutic Hypothermia in Cases of Near-Hanging and Recovered from Cardiac Arrest Due to Hanging. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791402100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective There is no specific treatment for comatose patients after near-hanging or in those who recover from cardiac arrest (CA) caused by hanging. Since 2009, we have used therapeutic hypothermia (TH) to treat all comatose survivors of near-hanging and in patients who recovered from CA caused by hanging. The purpose of this study was to describe the outcomes in comatose patients after near-hanging. Design Case series. Setting Emergency departments of two regional hospitals. Methods We collected patient data from the Samsung Medical Center hypothermia database between November 2009 and November 2011. We included all patients presented with near-hanging or CA caused by hanging; who remained comatose and received TH after resuscitation for analysis. Clinical characteristics and outcome of patients were presented. Results During the study period, 26 patients were admitted to the emergency department after near-hanging or CA caused by hanging; 21 patients were enrolled in this study. Twelve patients with CA and 9 comatose patients without CA were treated with TH. Only 1 patient with CA had a good neurological outcome. By contrast, all near-hanging patients without CA had a good neurological outcome. Conclusions TH can be an effective therapeutic modality in cases of near-hanging without CA. However, the effectiveness of TH is questionable in patients who survive from CA caused by hanging. (Hong Kong j.emerg.med. 2014;21:316-321)
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Affiliation(s)
- Yh Lee
- Hallym University Sacred Heart Hospital, Departments of Emergency Medicine, Hallym University, Anyang 431-070, Korea
- Samsung Changwon Hospital, Departments of Emergency Medicine, Sungkyunkwan University School of Medicine, Changwon 630-522, Korea
| | - Hc Ahn
- Hallym University Sacred Heart Hospital, Departments of Emergency Medicine, Hallym University, Anyang 431-070, Korea
| | - Yd Sohn
- Hallym University Sacred Heart Hospital, Departments of Emergency Medicine, Hallym University, Anyang 431-070, Korea
| | - Jy Ahn
- Hallym University Sacred Heart Hospital, Departments of Emergency Medicine, Hallym University, Anyang 431-070, Korea
| | - Sm Park
- Hallym University Sacred Heart Hospital, Departments of Emergency Medicine, Hallym University, Anyang 431-070, Korea
| | - Ck Hong
- Samsung Changwon Hospital, Departments of Emergency Medicine, Sungkyunkwan University School of Medicine, Changwon 630-522, Korea
| | - Sy Hwang
- Samsung Changwon Hospital, Departments of Emergency Medicine, Sungkyunkwan University School of Medicine, Changwon 630-522, Korea
| | - Ju Na
- Samsung Changwon Hospital, Departments of Emergency Medicine, Sungkyunkwan University School of Medicine, Changwon 630-522, Korea
| | - Dh Shin
- Samsung Changwon Hospital, Departments of Emergency Medicine, Sungkyunkwan University School of Medicine, Changwon 630-522, Korea
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5
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Emet M, Saritas A, Aslan S, Uzkeser M, Cakιr ZG, Coskun S. Cervical Spinal Injury and Hyoid Fracture in a Near-Hanging Victim. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791001700414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hanging is a kind of strangulation that involves suspension by the neck. A case of near-hanging is reported. The patient was a 56-year-old man with incomplete hanging. His initial Glasgow Coma Scale score was 8. Mild elevation of cardiac biomarkers and hyperglycaemia were found. Hyoid fractures and a slight anterior dislocation of the C6 vertebra were observed. In near-hanging victims, all hypoxia-sensitive organs should be examined carefully. Notwithstanding the different types of hanging (complete vs. incomplete), all victims should be assumed to have cervical injury until proven otherwise.
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Affiliation(s)
| | | | | | | | | | - S Coskun
- Ataturk University School of Medicine, Department of Neurosurgery, Erzurum 25090, Turkey
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Aneja J, Jangli S, Kulhara P, Bathla M. Neuropsychiatric sequelae of attempted hanging and diagnostic dilemmas. Ind Psychiatry J 2017; 26:239-242. [PMID: 30089976 PMCID: PMC6058448 DOI: 10.4103/ipj.ipj_46_15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Suicide is an important cause of death worldwide, and India is not immune to this major health problem. Suicide by hanging is one of the lethal methods widely practiced. However, literature is very sparse as well as old in the context of neuropsychiatric consequences seen in those who survive such attempts. We present a case of a young boy who survived an attempted hanging and was left with neuropsychiatric sequelae in the form of retro/anterograde amnesia, aggression, lability of affect, and impaired memory and visuomotor deficits. The associated diagnostic dilemmas, namely whether to diagnose such patients with Korsakoff's psychosis, organic amnesic syndrome, or major neurocognitive syndrome, are discussed and a brief review of literature of this largely ignored area is also presented.
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Affiliation(s)
- Jitender Aneja
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Satyarth Jangli
- Department of Psychiatry, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India
| | - Parmanand Kulhara
- Department of Psychiatry, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India
| | - Manish Bathla
- Department of Psychiatry, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India
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Abstract
Asphyxia may be broadly defined as any condition that leads to tissue oxygen deprivation. This article reviews traumatic causes of asphyxia, including the syn drome known as traumatic asphyxia, where a crush injury to the thoracoabdominal area gives the striking clinical triad of cervicofacial cyanosis and oedema, subcon junctival haemorrhage and cutaneous petechial haemorrhages of the face, neck and upper chest. Other traumatic causes of asphyxia reviewed are strangulation due to hanging and autoerotic asphyxiation. However bleak the initial prognosis may appear, any patient who presents with a history of asphyxiation should initially be resuscitated according to the prioritized approach: airway with cervical spine control, oxygenation and ventilation, and circulation. The clinical appearance of the patient is not an indicator of outcome. The identification and treatment of associated compli cations and injuries is vital, since these are a major cause of morbidity and mortality if the patient survives the initial asphyxiation insult.
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Mansoor S, Afshar M, Barrett M, Smith GS, Barr EA, Lissauer ME, McCurdy MT, Murthi SB, Netzer G. Acute respiratory distress syndrome and outcomes after near hanging. Am J Emerg Med 2014; 33:359-62. [PMID: 25596627 DOI: 10.1016/j.ajem.2014.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/31/2014] [Accepted: 12/03/2014] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The purpose of this study is to assess the case rate of acute respiratory distress syndrome (ARDS) after near hanging and the secondary outcomes of traumatic and/or anoxic brain injury and death. Risk factors for the outcomes were assessed. METHOD The method is a single-center, statewide retrospective cohort study of consecutive patients admitted between August 2002 and September 2011, with a primary diagnosis of nonjudicial "hanging injury." RESULTS Of 56 patients, 73% were male. The median age was 31 (Interquartile range (IQR), 16-56). Upon arrival, 9% (5/56) did not have a pulse, and 23% (13/56) patients were intubated. The median Glasgow Coma Scale (GCS) was 13 (IQR, 3-15); 14% (8/56) had a GCS = 3. Acute respiratory distress syndrome developed in 9% (5/56) of patients. Traumatic anoxic brain injury resulted in 9% (5/56) of patients. The in-hospital case fatality was 5% (3/56). Lower median GCS (3 [IQR, 3-7] vs 14 [IQR, 3-15]; P = .0003) and intubation in field or in trauma resuscitation unit (100% [5/5] vs 16% [8/51]; P = .0003) were associated with ARDS development. Risk factors of death were GCS = 3 (100% [3/3] vs 9% [5/53]; P = .002), pulselessness upon arrival of emergency medical services (100% [3/3] vs 4% [2/53]; P < .001], and abnormal neurologic imaging (50% [1/2] vs zero; P = .04). CONCLUSIONS The ARDS case rate after near hanging is similar to the general trauma population. Low GCS and intubation are associated with increased risk of ARDS development. The rate of traumatic and/or anoxic brain injury in this population is low.
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Affiliation(s)
- Sahar Mansoor
- Division of Pulmonary and Critical Care Medicine, University of Virginia School of Medicine, Charlottesville, VA.
| | - Majid Afshar
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Matthew Barrett
- Division of Pulmonary and Critical Care Medicine, and Department of Emergency Medicine, Christiana Care Health Services, Newark, DE
| | - Gordon S Smith
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Erik A Barr
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Matthew E Lissauer
- Department of Surgery, Division of Acute Care Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Michael T McCurdy
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD; Departmentof Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Sarah B Murthi
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Giora Netzer
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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9
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Abstract
Hanging is an important and increasingly common method of suicide in developed countries. Little is known about the true human pathophysiological changes and injury patterns associated with hanging and near hanging. Cervical spine injury is commonly reported; however, there is a paucity of large data sets concerning this injury. This review article focuses on the incidence of cervical spine and associated neck injuries and their role in morbidity and mortality following non-judicial hanging. A total of 26 heterogeneous studies were identified examining injury after hanging or near hanging. In total, there were 2795 patients; 1530 (54.7%) with true hanging and 1265 (45.3%) with near hanging. Cervical spine injury was reported in a total of 58 (2.08%) patients. Injuries to the airway and vessels of the neck seem rare. This is somewhat lower than the current accepted incidence for cervical spine injury after hanging or blunt force trauma. The overall incidence of cervical spine injury after hanging is low. Spinal immobilisation should probably be instituted depending on the mechanism of the hanging. However, a patient presenting with signs of life to an emergency department is unlikely to have a severe cervical spine injury.
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Affiliation(s)
- Marc Chikhani
- Academic Anaesthesia and Critical Care, Division of Clinical Neuroscience, The University of Nottingham, UK
| | - Robert Winter
- Academic Anaesthesia and Critical Care, Division of Clinical Neuroscience, The University of Nottingham, UK
- Nottingham University Hospitals NHS Trust, Medial Lead, Mid-Trent Critical Care Network, UK
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10
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Abstract
Although hanging is common across the world, survival after attempted hanging is very rare with death usually occurring within minutes or over the first 24 hours. If the person survives the initial event, later he/she may die because of the severity of the initial hypoxic and ischemic brain damage. Survival from hanging is often associated with various complications including a large variety of neurological consequences. This case report highlights a rare case of survival in attempted hanging of a 35-year-old man, with previous suicide ideation. Within 15 minutes of the incident, he was brought to a tertiary care hospital. On admission, he was unconscious and the Glasgow Coma Scale was 4 with tachycardia, weak pulse, bradypnea, and shallow breathing. With vigorous and prompt resuscitation methods, he gradually recovered without any residual neurological outcome. Prognostically good results could be achieved, if such victims are vigorously and promptly resuscitated, irrespective of their initial presentation.
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11
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Sadaka F. Therapeutic Hypothermia for Brain Injury from Near Hanging: Review of the Literature. Ther Hypothermia Temp Manag 2013; 3:13-6. [DOI: 10.1089/ther.2012.0022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Farid Sadaka
- Trauma and Neuro ICU, Mercy Hospital St. Louis/St. Louis University Hospital, St. Louis, Missouri
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12
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Kumar KJ, Jain M, Chavan A, Rani SS. Accidental self-strangulation in a child. J Pediatr Neurosci 2012; 6:164-5. [PMID: 22408679 PMCID: PMC3296424 DOI: 10.4103/1817-1745.92864] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- K Jagadish Kumar
- Department of Pediatrics, JSS Medical College, JSS University, Mysore, India
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13
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Solhi H, Pazoki S, Mehrpour O, Alfred S. Epidemiology and Prognostic Factors in Cases of Near Hanging Presenting to a Referral Hospital in Arak, Iran. J Emerg Med 2012; 43:599-604. [DOI: 10.1016/j.jemermed.2011.09.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 04/13/2011] [Accepted: 09/27/2011] [Indexed: 11/16/2022]
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Sauvageau A, Ambrosi C, Kelly S. Autoerotic nonlethal filmed hangings: a case series and comments on the estimation of the time to irreversibility in hanging. Am J Forensic Med Pathol 2012; 33:159-62. [PMID: 20562689 DOI: 10.1097/paf.0b013e3181ea1aa6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recent studies of filmed hangings have documented the agonic sequences in these deaths. Considering this agonic sequence, one question comes to mind: which of these responses is an indicator of irreversible damage? Since decerebrate rigidity points toward lesions of the midbrain, it was initially thought that this posture could be an indicator of severe potentially irreversible damage. However, we here present a series of nonlethal filmed hangings by a 35-year-old male autoerotic practitioner, which will prove otherwise: in a film of an interrupted hanging, a decerebrate pattern of rigidity was observed at 20 seconds. However, the man later regained consciousness and seemed to present a full recovery without any noticeable symptoms. The scientific basis for the generalized assumption that death by hanging occur in 3 to 5 minutes will be reviewed. Though this estimation of the time is certainly precise and accurate enough for the needs of clinicians, it will be demonstrated that scientific evidence are not strong enough to be used in court. So how long does it take to suffer irreversible damage by hanging or by strangulation? The only honest and scientifically valid answer seems to be that we do not know.
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Affiliation(s)
- Anny Sauvageau
- Office of the Chief Medical Examiner, Edmonton, Alberta, Canada.
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15
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Abstract
Hanging is a common method of suicide/homicide in the Indian scenario. We report three successive cases of attempted suicidal hangings seen over a period of 4 months in our intensive care wards. All of them presented gasping with poor clinical status and required immediate intubation, resuscitation, assisted ventilation and intensive care treatment. None had cervical spine injury, but one patient developed aspiration pneumonia. All the three patients received standard supportive intensive care and made full clinical recovery without any neurological deficit. We conclude that the cases of near hanging should be aggressively resuscitated and treated irrespective of dismal initial presentation. This is well supported by the excellent outcomes in our cases despite their poor initial condition.
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Aggarwal R, Anant S, Vardhan H. Pulmonary Oedema in a survivor of Suicidal Hanging. Med J Armed Forces India 2011; 60:188-9. [PMID: 27407619 DOI: 10.1016/s0377-1237(04)80120-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- R Aggarwal
- Classified Specialist (Anaesthesia), 9 Air Force Hospital, Halwara
| | - S Anant
- Classisfied Specialist (Anaesthesia), Command Hospital (Air Force), Bangalore
| | - Harsh Vardhan
- Classified Specialist (Anaesthesia), 5 Air Force Hospital, C/o 99 APO
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Sadaka F, Wood MP, Cox M. Therapeutic hypothermia for a comatose survivor of near-hanging. Am J Emerg Med 2010; 30:251.e1-2. [PMID: 21056923 DOI: 10.1016/j.ajem.2010.09.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 09/22/2010] [Indexed: 10/18/2022] Open
Abstract
Therapeutic hypothermia is recommended for comatose survivors of cardiac arrest. Therapeutic hypothermia ameliorates multiple pathophysiologic mechanisms involved in ischemia-reperfusion injury, which may occur after cardiac arrest and near-hanging. Therapeutic hypothermia has not been prospectively studied in near-hanging. Victims of near-hanging suffer from strangulation with cerebral ischemia and resultant reperfusion injury rather than a fatal cervical spine injury. We report a case where therapeutic hypothermia was applied to a comatose survivor of near-hanging. A 41-year-old man presented with coma following attempted suicide by hanging. The patient underwent 24 hours of mild therapeutic hypothermia. The patient was discharged without neurologic sequelae and a Modified Rankin Scale of 0 (back to his baseline status). We present a case where therapeutic hypothermia was used safely and successfully in a patient without cardiac arrest but still in coma after attempted suicide by hanging. No randomized controlled trials on therapeutic hypothermia for comatose survivors of near-hanging victims have been published. However, in the absence of better evidence, it seems reasonable to consider hypothermia treatment in comatose near-hanging victims until more evidence can be obtained.
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Affiliation(s)
- Farid Sadaka
- Critical Care Medicine Department, Neurocritical Care Medicine, St. John's Mercy Medical Center, St. Louis University, St Louis, MO, USA.
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18
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Jehle D, Meyer M, Gemme S. Beneficial response to mild therapeutic hypothermia for comatose survivors of near-hanging. Am J Emerg Med 2010; 28:390.e1-3. [PMID: 20223413 DOI: 10.1016/j.ajem.2009.07.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 07/23/2009] [Indexed: 10/19/2022] Open
Abstract
Therapeutic hypothermia has been shown to clearly benefit comatose survivors of cardiac arrest. It is reasonable to postulate that if therapeutic hypothermia is beneficial for the neurological injury of cardiac arrest, then it may have a role in the treatment of near-hanging suffocation injuries. We report a retrospective series of 2 patients who received mild therapeutic hypothermia for their comatose state after a near-hanging injury. The exclusionary criteria and protocols that we use for comatose survivors of cardiac arrest were used. After at least 24 hours of mild therapeutic hypothermia, both patients had a complete return of neurological function, with Glasgow Coma Scale scores of 15 at the time of discharge from the hospital. These data, taken with other case series, suggest that therapeutic hypothermia may be beneficial for comatose survivors of near-hanging.
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Affiliation(s)
- Dietrich Jehle
- Department of Emergency Medicine, Erie County Medical Center, Buffalo, NY, USA.
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19
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Borgquist O, Friberg H. Therapeutic hypothermia for comatose survivors after near-hanging—A retrospective analysis. Resuscitation 2009; 80:210-2. [DOI: 10.1016/j.resuscitation.2008.10.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 09/30/2008] [Accepted: 10/08/2008] [Indexed: 11/29/2022]
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20
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Trujillo MH, Fragachan CF, Tortoledo F. Noncardiogenic pulmonary edema following accidental near-hanging. Heart Lung 2007; 36:364-6. [PMID: 17845882 DOI: 10.1016/j.hrtlng.2006.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2006] [Accepted: 10/30/2006] [Indexed: 11/24/2022]
Abstract
A 79 year-old woman was admitted to our institution unconscious with pulmonary edema. She had been trapped by the neck in the electric sliding gate of her own home garage. A pulmonary artery catheter was inserted through the right internal jugular vein and her hemodynamic profile and chest x ray revealed a non cardiogenic pulmonary edema. Intensive care management consisted of assisted/controlled ventilatory support with low grade of PEEP (6 cm H2O) and loop diuretics. Three days later, the chest x-ray showed resolution of the pulmonary edema and she made a full recovery. Near-hanging due to neck compression can be a life-threatening cause of non-cardiogenic pulmonary edema, and should be included in the differential diagnosis of pulmonary edema.
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Affiliation(s)
- Maximo H Trujillo
- Critical Care Unit of The Instituto Medico La Floresta, Caracas, DC, Venezuela
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Morris C, Reid M. Attempted Suicide by Hanging. J Intensive Care Soc 2005. [DOI: 10.1177/175114370500600216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Craig Morris
- Department of Anaesthesia and Intensive Care Medicine Ulster Hospital Upper Newtownards Road Dundonald, Belfast BT161RH Northern Ireland
| | - Mark Reid
- Department of Anaesthesia and Intensive Care Medicine Ulster Hospital Upper Newtownards Road Dundonald, Belfast BT161RH Northern Ireland
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Gunnell D, Bennewith O, Hawton K, Simkin S, Kapur N. The epidemiology and prevention of suicide by hanging: a systematic review. Int J Epidemiol 2005; 34:433-42. [PMID: 15659471 DOI: 10.1093/ije/dyh398] [Citation(s) in RCA: 172] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Hanging is one of the most commonly used methods for suicide worldwide. In England and a number of other countries, its incidence has increased over the last 30 years. This review summarizes the published literature on suicide by hanging. The focus is on its epidemiology in England and on identifying potential means of prevention. METHODS We searched Medline (1966-2003), Embase (1980-2003), CINAHL (1982-2003) and PsycINFO (1967-2003). As considerable research on suicides occurring in prisons and psychiatric hospitals in England and Wales has been carried out by the National Confidential Inquiry into Suicide and Homicide (Manchester) and the Prison Service's Safer Custody Group, we obtained additional information from these sources. RESULTS Only a small proportion (around 10%) of hanging suicides occur in the controlled environments of hospitals, prisons, and police custody; the remainder occur in the community. The most commonly used ligatures (rope, belts, flex) and ligature points (beams, banisters, hooks, door knobs, and trees) are widely available; thus prevention strategies focused around restriction of access to means of hanging are of limited value. Around 50% of hanging suicides are not fully suspended--ligature points below head level are commonly used. Case fatality following attempted suicide by hanging is around 70%; the majority (80-90%) of those who reach hospital alive survive. CONCLUSION Strategies to reduce suicide by hanging should focus on the prevention of suicide in controlled environments, the emergency management of 'near-hanging' and on the primary prevention of suicide in general. More research is required to better understand the recent rise in popularity of this method.
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Affiliation(s)
- David Gunnell
- Department of Social Medicine, University of Bristol, Bristol BS8 2PR, UK.
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Abstract
This paper reports 13 cases of near-hanging presenting to the Accident and Emergency (A + E) Department of a District General Hospital over a 52-month period. The purpose of the study was to analyse the epidemiology, methods, outcomes and complications of near-hanging. There were 13 cases in the study period, 12 of whom were male and 1 female. The mean age was 31 years. The most common method used was rope (five cases). The estimated mean duration of hanging was 5 min. Height of fall data was poorly recorded but only one fall was recorded as being more than 3 ft. Many had a very poor clinical picture on arrival of the ambulance crews: seven had a Glasgow Coma Score (GCS) of less than or equal to 8 on scene, of which five required intubation. Five patients required ventilation and a period of treatment on the Intensive Therapy Unit (ITU). There were no cervical spine (C-spine) injuries, nor neurological complications. There were two incidences of aspiration pneumonia. All of the patients made a full recovery. It is concluded that patients presenting with this injury go on to make a full recovery, despite an often dismal initial clinical picture.
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Affiliation(s)
- S J Hanna
- Accident and Emergency Department, Milton Keynes General Hospital, Eaglestone, Milton Keynes MK6 5LD, UK.
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24
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Davidson JA. Presentation of near-hanging to an emergency department in the Northern Territory. EMERGENCY MEDICINE (FREMANTLE, W.A.) 2003; 15:28-31. [PMID: 12656783 DOI: 10.1046/j.1442-2026.2003.00404.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the epidemiology and outcomes of patients presenting after near-hanging to an emergency department in the Northern Territory of Australia. METHODS A descriptive retrospective review of hospital and retrieval records was made of all patients presenting to the Royal Darwin Hospital between January 1995 and August 2000 as a result of near-hanging. RESULTS There were 72 patients who presented after near-hanging in the study period. The majority of patients were young adult males of Aboriginal descent living in the Tiwi Islands. Psychiatric and drug abuse histories were a prominent feature. No cervical spine injuries were detected and there were no neurological deficits in the survivors. CONCLUSION Near-hanging appears to be a significant problem among young indigenous males, especially those from the Tiwi Islands. Strategies to identify risk factors linked to suicide and to help empower families to reduce the incidence of self-harm are integral to addressing this problem.
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Strack GB, McClane GE, Hawley D. A review of 300 attempted strangulation cases. Part I: criminal legal issues. J Emerg Med 2001; 21:303-9. [PMID: 11604294 DOI: 10.1016/s0736-4679(01)00399-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Three hundred strangulation cases, submitted for misdemeanor prosecution to the San Diego City Attorney's Office, were evaluated to determine the signs and symptoms of attempted strangulation that could be used to corroborate the victim's allegation of being "choked" for purposes of prosecution. The study reveals that a lack of training may have caused police and prosecutors to overlook symptoms of strangulation or to rely too heavily on the visible signs of strangulation. Because most victims of strangulation had no visible injuries or their injuries were too minor to photograph, opportunities for higher level criminal prosecution were missed.
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Affiliation(s)
- G B Strack
- San Diego City Attorney's Office, San Diego, California 92101, USA
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Hawley DA, McClane GE, Strack GB. A review of 300 attempted strangulation cases Part III: injuries in fatal cases. J Emerg Med 2001; 21:317-22. [PMID: 11604296 DOI: 10.1016/s0736-4679(01)00401-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A review of 300 cases of alleged strangulation assault, submitted for misdemeanor prosecution by the San Diego City Attorney's Office, led to a search for medical evidence that would be useful to prosecute these cases (see Strack et al. in this issue of the Journal). The injuries identified in these non-fatal cases are similar to injuries found in fatal domestic violence strangulation assaults. This article reviews the injuries recognizable at autopsy in cases of strangulation in domestic violence victims.
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Affiliation(s)
- D A Hawley
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine,;, Indianapolis, Indiana 46202-5120, USA
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Aggarwal NK, Kishore U, Agarwal BB. Hanging-delayed death (a rare phenomenon). MEDICINE, SCIENCE, AND THE LAW 2000; 40:270-272. [PMID: 10976192 DOI: 10.1177/002580240004000314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Hanging is one of the most common methods of suicide in India in which death of the individual occurs instantaneously. However, a few cases have been reported in literature in which death has occurred after a certain period of time or the patient has survived after prolonged resuscitative measures. A case of a 20-year-old female is described who survived for nine days after hanging, remaining unconscious throughout in the hospital. She died due to cerebral damage caused by cerebral anoxia.
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Affiliation(s)
- N K Aggarwal
- Department of Forensic Medicine, UCMS and GTB Hospital, Delhi, India
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Abstract
Relatively little is known about death in children following hanging. This 12-year retrospective study in southeast Scotland revealed 12 such deaths among children <15 years of age, involving 10 boys and 2 girls. The rate of hanging deaths was 0.7 deaths/100,000 children/year and was equal to that from falls in children during this time period. The children who died following hanging were aged between 4 and 14 years. All 12 children were in cardiac arrest when found, and 11 were declared dead at the scene, demonstrating the limited potential to reduce the death rate through improved treatment. Scrutiny of the circumstances surrounding each death suggested that 6 of the deaths were accidents and 6 were suicides. There appears to be some, albeit limited, potential to prevent some hanging deaths in children through increased parental supervision, education, and restriction of access to ligatures.
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Affiliation(s)
- J P Wyatt
- Accident and Emergency Department, Royal Infirmary, Edinburgh, Scotland, UK
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