# Treatment of a hanging victim



## Foxbat (Apr 3, 2009)

After reading a thread about suicides and listening to hanging call on the scanner, I am wondering... What can you do on a BLS level for a hanging victim (the rope is cut, pt. is breathing), other than O2 and spinal immobilization? What should you expect and why - deteriorating airway, shock? What is the pathophysiology?


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## Shishkabob (Apr 3, 2009)

If they are breathing, then they aren't a hanging... just like you can't drown and live.


But, rope burn could be a consideration.  Collapsed trachea.  Rupture of blood vessels in the neck region (not really anything you can do)


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## Ridryder911 (Apr 3, 2009)

Actually one can be hanged and be a post arrest. Other major potential injuries are of course "hangman's fracture"(fxr hyoid bone); asphyxia, ruptured trachea and esophageal collapse. 

One could expect aggressive airway management such as having to perform crich, etc. 

R/r911


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## rhan101277 (Apr 4, 2009)

Yes the good old hyoid bone, doesn't connect to any other bones


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## 8jimi8 (Apr 4, 2009)

bls other than what you mentioned? jaw thrust. (hopefully you have a medic next to you who can intubate a difficult airway)

read about distraction injuries.


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## CAOX3 (Apr 4, 2009)

If its a complete hanging, versus in incomplete.  C2 fracture and transection of the spinal chord is usually the cause of death.  These people if viable, usually not, will usually receive BLS airways due to the magnitude of airway damage.

I have done a couple hangings one was an incomplete, meaning a portion of the patient was touching the ground, or not supporting the total body weight.  This person received a BLS airway and didn't survive.  The others were not viable candidates for resuscitation.


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## vquintessence (Apr 5, 2009)

Foxbat said:


> ... What should you expect and why - deteriorating airway, shock? What is the pathophysiology?



A good scene documentation/size up will help ED.  Ex:  Did pt kick a chair from under him, or did he jump down from a good height before the rope gigged him?  The difference in the two will give more insight as to what to initially suspect.

Airway was already mentioned, but as far as pathophysiology, the guys C2 (is it C2? Can't remember for sure) just took an almost direct insult.  Look for signs of neurogenic shock & damage.  Focus on skin condition, BP dropping due to the bodies failure to maintain vasoconstriction, deteriorating CSM, etc.


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## Coptrainer (Apr 11, 2009)

I know you're asking from the medical point of view but. . .

Remember, too, that Law Enforcement will want the knot to be intact.  Do not untie the knot or cut through it unless that is your only option.  That includes the knot at the neck and the knot at the anchor point.


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## Airwaygoddess (Apr 11, 2009)

*To think about also.......*

Something else to thing about, crime scene preservation.........  same goes also if all possible to not cut thru any holes made from GSW or knife wounds....


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## mycrofft (Apr 11, 2009)

*Been to three.*

I think "hangman's fx" is C1 and/or C2. Strangler's fx is hyoid.
Knots don't untie and are harder to cut than the main strands. Our officers carry a V-blade "cutdown knife"; I cut one down with cheap little stainless Lister-style nursing scissors.
Most amateur hangings result in strangulation, which is cutoff of airway AND neck vasculature if done "right". If not done "right", you get jugular obstruction but not carotid, resulting in gruesome coloring, swelling and inflatons of the face and head (analogous to the TK you use to start an IV or draw blood).
In the correctional setting I work in, the majority of attempts are really sub-lethal, but the potentially lethal ones nearly always result in death.


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## Ridryder911 (Apr 11, 2009)

Actually there are two hangman's fxr.'s Our neighbors in Europe use the knot to the side of the neck causing a C1 C2 (atlas/axis) spinal fracture while we use the knot behind the neck causing a fracture of the hyoid bone as well with some strangulation. (a little something I learned from an M.E.)

If the knot is not tied properly then yes, you will have strangulation instead of fracturing and tearing the spinal cord. 

When releasing the victim, CSI guys have always informed me to to cut mid-way and allow enough rope without disturbing the knot if possible. There are many details upon the knot can be made. 

R/r 911


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