brief description for strangulation patient report

Why should healthcare providers recognize signs of strangulation?

By recognizing signs of strangulation, healthcare providers can help to mitigate long-term damage, properly document any evidence of abuse, and provide referrals for seeking safety assistance.

What is strangulation in domestic violence?

Strangulation has been identified as one of the most lethal forms of domestic violence. It is one of the best predictors for subsequent homicide. Prior strangulation increases the odds of strangulation homicide by more than seven times. 1 For perpetrators, strangulation is the ultimate form of power and control.

How accurate are accurate assessments of strangulation victims?

Accurate assessment of strangulation victims is crucial to decreasing postincident health impacts. According to the Centers for Disease Control and Prevention (CDC), between 2003 and 2014, 55.3% of female homicide victims in the United States were the result of intimate partner violence (IPV).

What are the long-term effects of strangulation?

The effects of strangulation can be delayed. Nonfatal strangulation victims are at increased risk for homicide after the first incident. Accurate assessment of strangulation victims is crucial to decreasing postincident health impacts.

How do you describe strangulation?

Strangulation is a form of asphyxia (lack of oxygen) characterized by closure of the blood vessels and or air passages of the neck as a result of external pressure on the neck. Absence of a visible injury is common while symptoms of internal injuries may be present. Strangulation is a high lethality crime.

What does a strangulation victim look like?

Common visible signs of strangulation include petechiae (red spots) in the eyes, blood-red eyes, swollen lips, and cord, rope burns, scratches, and bruising (particularly on the neck).

What evidence is typically found when a strangulation occurs?

Objective signs noted in strangulation victims include involuntary urination and defecation. Miscarriages have been anecdotally reported occurring hours to days later. Visible injuries to the neck include scratches, abrasions, and scrapes.

What is a more common findings in manual strangulation?

As in strangulation by ligature, the typical findings are congestion of the head with (at least temporary) cyanosis, petechial hemorrhages, and sometimes bleeding from the mouth, nose, or ears.

What happens to your body during strangulation?

Strangulation (strangling) is when something presses or squeezes on your neck. The squeezing may stop the blood supply going to your brain, or it may stop the air going to your lungs. It may make you lose consciousness (black out) and stop breathing.

What are the after effects of strangulation?

Be aware that strangulation may cause the following symptoms and/or consequences: difficulty breathing, raspy, hoarse or loss of voice, coughing, difficulty swallowing, drooling, nausea, vomiting, changes in behavior, hallucinations, headaches, light heaedness, dizziness, urination or defecation, miscarriage, swollen ...

What are the signs and symptoms of strangulation?

Symptoms of StrangulationVoice changes - raspy and/or hoarse voice, coughing, unable to speak, complete loss of voice.Swallowing changes - trouble swallowing, painful swallowing, neck pain, nausea/vomiting, drooling.Breathing changes - difficulty breathing, hyperventilation, unable to breathe.More items...

What's another word for strangulation?

In this page you can discover 8 synonyms, antonyms, idiomatic expressions, and related words for strangulation, like: strangling, choking, throttling, suffocation, asphyxiation, electrocution, dismemberment and decapitation.

How can a coroner tell if someone was strangled?

There are non-specific physical signs used to attribute death to asphyxia. These include visceral congestion via dilation of the venous blood vessels and blood stasis, petechiae, cyanosis and fluidity of the blood. Petechiae are tiny hemorrhages.

How can medical examiner determine strangulation?

According to Wilber et al. (2001) some of the most common assessment findings seen in strangulation victims include the signs and symptoms of odynophagia, neck pain, dyspnea, petechiae on the skin, and linear red marks on the skin.

What are three types of strangulation?

Strangulation is defined as asphyxia by closure of the blood vessels and/ or air passages of the neck as a result of external pressure on the neck. [2] It is subdivided into three main categories: hanging, ligature strangulation and manual strangulation.

What are the 2 types of strangulation?

Hanging occurs when a person is suspended with a ligature around his or her neck, which constricts due to the gravitational pull of the person's own body weight. Ligature strangulation occurs when the pressure applied around the neck is with a ligature only.

What happens if you are strangled?

Patients who have been strangled may present with pulmonary complaints, which are often mistakenly attributed to hyperventilation. Aspiration or postobstructive pulmonary edema may result in tachypnea and hypoxia. Occlusion of or injury to one carotid artery may cause neurological deficits on the contralateral side.

How many times does strangulation increase the odds of homicide?

It is one of the best predictors for subsequent homicide. Prior strangulation increases the odds of strangulation homicide by more than seven times. 1 For perpetrators, strangulation is the ultimate form of power and control.

What happens if you strangulate the carotid artery?

Occlusion of or injury to one carotid artery may cause neurological deficits on the contralateral side. These include changes in vision, ptosis, facial droop, and unilateral weakness.4 If strangulation results in hypoxia, patients may have mental status changes and incontinence.

What causes delayed death?

Delayed mortality may be caused by carotid artery dissection, aspiration, postobstructive pulmonary edema, acute respiratory distress syndrome, or tracheal injury. In domestic violence and sexual assault cases, manual strangulation (with hands or other body parts such as a knee) is most common.

What is the term for the closure of the blood vessels and air passages of the neck?

Strangulation is a form of asphyxia, characterized by closure of the blood vessels and air passages of the neck as a result of external pressure. There is a distinction between strangulation and choking, which is an internal obstruction of the airway.

What is the neck area vulnerable to?

The vasculature of the neck is relatively unprotected and vulnerable to injury and vascular occlusion. The application of 4.4 pounds of pressure to the jugular veins causes venous outflow obstruction from the brain and thus stagnant hypoxia.

Does strangulation cause physical damage?

Frequently, strangulation does not result in visible physical findings.3 The lack of obvious injury, along with the distraught mental state of these patients, often results in underevaluation. It is important to perform a thorough exam, as findings may be subtle and located in difficult to see areas such as the scalp, behind the ears, and inside the mouth.

How long does it take for a person to die from strangulation?

This pressure can lead to a loss of consciousness within five to ten seconds and cause death within a few minutes. Because such a thin line exists between unconsciousness and death, strangulation sits just before homicide on ...

How to tell if someone is strangled?

Common visible signs of strangulation include petechiae (red spots) in the eyes, blood-red eyes, swollen lips, and cord, rope burns, scratches, and bruising (particularly on the neck). When someone is being strangled, they will often try to regain control of their airway, by trying to pry the hands of the perpetrator off ...

Why do people lose consciousness when they are strangulated?

During an incidence of strangulation, closing off the airway makes breathing impossible, and a victim may lose consciousness due to the blocking of blood flow to and from the brain. Strangulation may obstruct the carotid arteries in the neck, depriving the brain of oxygen. Unconsciousness may also occur due to the blocking ...

What is the term for the obstruction of blood vessels and/or airflow in the neck resulting in asphyxia

The Training Institute on Strangulation Prevention defines strangulation as “the obstruction of blood vessels and/or airflow in the neck resulting in asphyxia.”. This type of assault can have serious, permanent, or even fatal damage to the victim’s throat or brain. Data on strangulation reveals a glaring picture of the severity of this type ...

What should forensic nurses take notes on?

Forensic nurses should also take detailed accounts in their forensic exam notes with the exact date and time to monitor the progression of signs and symptoms. When in doubt, medical professionals can consult with experts during a forensic exam for guidance on recognizing strangulation.

What is a safety plan for domestic violence?

A safety plan essentially outlines the resources available to domestic violence victims and what to do in specific situations whether they decide to stay with or leave their abuser. Collaborate with local domestic violence service providers, shelters, and members of law enforcement to build a base of referrals.

What happens to the throat after a heart attack?

Immediately after the attack, the person may experience intense pain, vision changes, ringing in the ears, a swollen tongue, cuts in the mouth, swelling of the neck, difficulty swallowing, trouble breathing, or voice and throat changes. The victim may also experience neurological damage due to a lack of oxygen flow to the brain.

How to detect strangulation in an emergency?

The detection of strangulation and its effects on a patient can be challenging for emergency nurses despite their level of skills and expertise .1,2 Strangulation can occur with very little pressure to the neck, therefore physical signs and symptoms are not always obvious and can easily be missed by healthcare providers.1 The patient may not report that strangulation occurred for various reasons, making evaluation of these patients more difficult. Having an index of suspicion for strangulation during the assessment may help detect these injuries when they are insidious.1 The incidence of strangulation, particularly hangings, has increased in the United States and worldwide.3 While the emergency nurse is prepared to manage airway obstructions and hypoxia, he or she may have limited understanding of the complexities surrounding strangulation, including assessment, signs and symptoms, nursing implications, and other challenges such as those associated with intimate partner violence (IPV), risky personal behaviors, forensic evidence collection, and suicide. The emergency nurse who knows the mechanisms of strangulation injuries and the associated social factors, is well-positioned to quickly identify risks that may not be immediately evident.4

What happens if you strangulate your neck?

Strangulation is defined as an external pressure applied to the neck that compresses the blood vessels and potentially the airway.1,5 A pressure of only 11 pounds per square inch (PSI) applied for 10 seconds to both carotid arteries can cause unconsciousness; permanent brain damage can result if pressure is sustained for two minutes6, and brain death can occur if pressure is sustained for three to five minutes.1 Suffocation, choking, and strangulation can all lead to a lack of oxygen to the body (asphyxia), but each is different (see Definitions).

Can strangulation be fatal?

Strangulation can be lethal, but those who survive a strangulation attempt suffer from short and long-term consequences. Patients who have a low Glasgow coma scale (GCS) score and require mechanical ventilation following a near-hanging or strangulation are at risk of developing acute respiratory distress syndrome (ARDS).21 Also, patients will have a high mortality rate, especially if they arrive to the ED pulseless and have abnormal neurological radiology exams.21 Another potential short-term sequela is the development of thyroid storm.22 Researchers conducted a post-mortem analysis that revealed microscopic changes in the thyroid glands of patients who had sustained traumatic injuries to the neck.22

Abstract

Non-fatal strangulation is a dangerous mechanism of injury among survivors of intimate partner violence and sexual assault, with inadequate evidence to guide investigation in the emergency department (ED).

Résumé

La strangulation non mortelle est un mécanisme dangereux de blessures chez les survivants de violence conjugale et d’agression sexuelle, avec des preuves insuffisantes pour guider l’enquête aux services d’urgence (SU).

Methods

We conducted a health records review from January 1st, 2015 to December 31st, 2018 of patients treated at the SAPACP of TOH. TOH is a tertiary level hospital in Ottawa, Canada. TOH SAPACP is the sole hospital-based center for intimate partner violence and sexual assault cases in the region.

Results

Between January 2015 and December 2018, 1791 patients presented to the SAPACP program from which 209 (11.7%) non-fatal strangulation cases were identified. Median age was 27 years (IQR: 21–36), and 97.6% were female. Manual strangulation was the primary manner of strangulation (95.7%).

Discussion

This work provides insight into the medical and radiological evaluation of non-fatal strangulation survivors. Many of the severe cases were related to the presence of concomitant head trauma, and only three cases had significant findings directly related to the strangulation event.

Conclusion

We found over 10% prevalence of non-fatal strangulation in survivors of intimate partner violence or sexual assault. There was a low rate of clinically important injury on the index ED visit secondary to non-fatal strangulation. Severe injury was primarily secondary to concomitant trauma.

The Case

Strangulation and Domestic Violence

• An NFS can range from mild and transitory to serious and life-threatening, and it may result in injuries such as carotid artery dissection, thrombosis, or embolism, as well as bruising or fracture of the larynx, hyoid bone, tracheal rings, or thyroid cartilage. Subjective data indicating possible strangulation include: 1. neck or throat pain 2. dis...

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Pathophysiology

Clinical Findings