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Neck Injury by Strangulation/hanging

Neck Injury by Strangulation/hanging is a topic covered in the 5-Minute Emergency Consult.

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  • Strangulation:
    • Ligature: Material used to compress structures of neck
    • Manual: Physical force used to compress structures of neck
    • Postural: Airway obstruction from body weight (over an object) or position (typically in infants)
  • Hanging is a form of strangulation:
    • Complete (judicial type): Victim's entire body is suspended off the ground
    • Incomplete (nonjudicial): Some part of victim's body contacts the ground
    • Typical: The point of suspension is placed centrally over the occiput.
    • Atypical: The point of suspension is in any position other than over the central occiput.
    • Intentional: Suicide, homicide, autoerotic, “the choking game”
    • Accidental: Often children or clothing caught in machinery
    • Near-hanging: Survival following nonjudicial hanging


  • Hanging (judicial):
    • Victim is dropped a distance at least equal to his or her height
    • Forceful distraction of head from torso results in a decapitation type of injury (fracture of cervical spine and transection of spinal cord)
  • Hanging (nonjudicial):
    • Typically occurs from a lower height
    • Injuries mimic nonjudicial strangulation
  • Strangulation:
    • External neck pressure causes cerebral hypoxia secondary to venous and arterial obstruction.
    • Pressure on neck structures may cause airway, soft tissue, and vascular injuries.
    • Cervical spine injuries are uncommon except with judicial-type hanging.
  • Death:
    • Secondary to mechanical closure of blood vessels or airway
    • Secondary to cardiac arrest from extreme bradycardia due to increased vagal tone from carotid sinus pressure
    • Secondary to direct neurologic injury to the spinal cord
    • Secondary to pulmonary complications in near-hanging victims
    • Secondary to cerebral hypoxia

Commonly Associated Conditions

  • Cervical spine injury
  • Hypoxic cerebral injury
  • Arterial or venous dissection/thrombosis
  • Hyoid bone fracture:
    • Typically seen in nonjudicial strangulation
  • Cricoid cartilage disruption (rare)
  • Thyroid cartilage disruption:
    • More common in nonjudicial strangulation deaths
  • Phrenic nerve injury
  • Airway edema
  • Aspiration pneumonitis (may be late)
  • Neurogenic pulmonary edema (may be late):
    • Due to massive central sympathetic discharge
  • Postobstructive pulmonary edema (may be rapid onset):
    • Due to negative intrapleural pressure resulting from inspiration against an external airway obstruction
  • Air embolism:
    • Consider when SC air and vascular injuries are present

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Rosen, Peter, et al., editors. "Neck Injury By Strangulation/hanging." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307394/all/Neck_Injury_by_Strangulation_hanging.
Neck Injury by Strangulation/hanging. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307394/all/Neck_Injury_by_Strangulation_hanging. Accessed April 23, 2019.
Neck Injury by Strangulation/hanging. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307394/all/Neck_Injury_by_Strangulation_hanging
Neck Injury By Strangulation/hanging [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307394/all/Neck_Injury_by_Strangulation_hanging.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Neck Injury by Strangulation/hanging ID - 307394 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307394/all/Neck_Injury_by_Strangulation_hanging PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -