Hanging and Near Hanging

Question 1

Types of hanging

Answer 1

Complete Hanging: complete free suspension of the body
Hanging with incomplete suspension: some part of the body is still in contact with the floor
Near Hanging: Patients who survive the initial hanging and reach hospital
Judicial Hanging: capital punishment, leading to fracture dislocation of the cervical spine and spinal cord

Question 2

Mechanisms of death from hanging

Answer 2

• C2 bilateral pedicle fracture (Hangman’s fracture) leading to the spinal cord being severed.
• Compression of vasculature in the neck
• Compression of the trachea
• Vagal stimulation and inhibition of the heart due to the pressure on the carotid baroreceptor

Question 3

Associated injuries common in near-hanging events

Answer 3

• Arrhythmias
• Negative pressure pulmonary oedema
• ARDS
• Vertebral artery dissection
• Cerebral thrombosis
• SAH
• SIRs like response

Question 4

Intubation considerations for patients admitted following near-hanging events

Answer 4

• Unlikely to be cooperative or conscious so AFOI is a no go
• Recommended to have VL and ETT mounted on a fibreoptic scope to assess airway for possible injuries and place tube distal to this
• No cricoid pressure
• Maintain MILS if possible