Hanging: pathophysiological and clinical aspects, routing of the victim (clinical lecture)
Keywords:review, hanging, strangulation asphyxia
AbstractStrangulation asphyxia is an acute airway obstruction due to direct compression of the trachea, blood vessels and nerve trunks of the neck. It leads to fast increase of hypoxemia and hypercapnia, deep cerebral circulation disorder and hypoxic/anoxic encephalopathy. In Ukraine, hanging is the most common way of suicide, in which mortality can reach 70 %. The extent of damage and the outcome depend on the duration of strangulation, the material and mobility of the loop, location of the knot and strangulation furrow, as well as the hanging mechanism — with a jerk, quickly or slowly. The article discusses pathophysiological changes and their clinical manifestations depending on the listed factors, as well as first aid algorithms at the prehospital stage and schemes for subsequent examination and treatment in a hospital. Strangulation asphyxia is accompanied by multiple organ failure with the development of combined or metabolic acidosis, hyperlactatemia, hyperkalemia, an inflammatory reaction, possibility of rhabdomyolysis, cytolytic syndrome, acute kidney damage, DIC. It can be accompanied by injuries of the cervical spine, trachea and larynx, crushing of the neck muscles, ruptures of the cervical arteries, damage to the spinal cord and medulla oblongata, and internal hemorrhages. First aid measures include loosening, immobilization of the cervical spine, emergency oxygenation, anticonvulsant, decongestant, fluid therapy, prevention of myoglobinuric nephrosis, and, if necessary, cardiopulmonary resuscitation and/or antiarrhythmic therapy. At the hospital stage, instrumental studies are carried out, if necessary, mechanical ventilation, specialists are involved, depending on the prevailing pathology. Syndromic therapy of emerging disorders may include treatment of ARDS and pneumonia, DIC, surgical procedures on the cervical spine, administration of non-hemoglobin oxygen carriers, decongestion, diuretic, anticonvulsant therapy, correction of acid-base and water-electrolyte balance disorders, as well as nootropic therapy for treatment of posthypoxic/postanoxic encephalopathy. After completing the course of treatment, patients who have a strangulation injury as a result of a suicide attempt should receive psychiatric help.
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