Hanging or strangulation account for 15% of all suicides or approximately 4000 deaths yearly with hanging being the most common method of suicide amongst inmates. The male to female ratio is 4:1.

Definitions: hanging is defined as a form of strangulation in which constriction around the neck is caused by an external mechanism, tightened by the weight of the victim’s partially or wholly suspended body. There are several different classifications. Typical vs. atypical- in a typical hanging the point of suspension is central over the occiput; atypical are all others. Complete vs. incomplete- with a hanging considered complete if the whole body is suspended and incomplete if some part of the body touches the ground. Finally, there is judicial vs. suicidal. In a judicial hanging the distance the victim drops is usually equal to his or her height, thus cervical dislocation and disruption of the spinal cord is the cause of death. Dislocation of the cervical vertebrae is rarely seen in cases of suicidal hanging because no long drop is involved. Death is caused by cerebral anoxia (see below).

Physiology: as noted, death is the result of cerebral anoxia caused by compression of the nerves and vessels in the neck. Occlusion of the upper airway by constriction of the neck is thought to be rare , however closure of the airway is caused by upward displacement of the tongue and epiglottis. Cardiac arrest may ensue from pressure on the vagus nerve or carotid sinus.

Most survivors of the initial trauma later die of pulmonary edema, aspiration pneumonia, or ARDS.

Delayed airway obstruction has been observed secondary to hemorrhage or edema formation or to fracture of the hyoid bone.

Survivors often exhibit memory loss, restlessness, and confusion.

Treatment: initial care and resuscitation are crucial.

Free victim, then ABC’s taking care to immobilize the neck until the c-spine is cleared.

Full supportive care including O2 and intubation if indicated. Vasopressor support often needed and patient should be monitored for cardiac arrhythmias.

Check chest X- ray to r/o asp. or pulmonary edema.

Send blood and urine for drug screens to r/o concurrent ingestions.

Manage increased intracranial pressure with hyperventilation, mannitol, steroids.

Patients who appear to be neurologically intact should be observed for at least 24 hours because of the threat of delayed airway obstruction.

Survivors should, of course, be evaluated by psych.