RT Book, Section
A1 Smock, William S.
A1 Stack, Lawrence B.
A2 Knoop, Kevin J.
A2 Stack, Lawrence B.
A2 Storrow, Alan B.
A2 Thurman, R. Jason
SR Print(0)
ID 1181057291
T1 Strangulation Injuries
T2 The Atlas of Emergency Medicine, 5e
YR 2021
FD 2021
PB McGraw-Hill
PP New York, NY
SN 9781260134940
LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1181057291
RD 2024/04/19
AB Manual  strangulation  is  one  of  the  most  lethal  forms  of  intimate  partner  violence  and  demonstrates  the  abuser’s  power  and  control  over  the  victim.  The  brain  will  suffer  an  anoxic  injury  when  the  flow  of  oxygenated  blood  is  stopped  by  occlusion  of  the  carotid  arteries.  Strangulation  victims  report  visual  and  auditory  changes  just  prior  to  a  loss  of  consciousness.  The  loss  of  bladder  control  indicates  a  deep  anoxic  insult  to  the  brain  of  at  least  15  seconds  in  duration.  The  loss  of  bowel  control  occurs  with  carotid  artery  occlusions  of  greater  than  30  seconds.  The  jugular  veins  can  be  occluded  with  4.4  psi,  the  carotids  with  11  psi,  and  the  trachea  with  34  psi.  Occlusion  of  venous  return  can  cause  capillary  rupture  from  increased  pressure  and  the  development  of  petechial  hemorrhage  (Figs.  19.32,  19.33,  19.34).  Petechial  hemorrhages  can  develop  in  any  vascularized  tissue,  including  the  brain.  The  most  sensitive  areas  for  petechial  hemorrhage  development  include  the  conjunctiva,  sclera,  and  intraoral  mucosa.  The  use  of  an  oral-pharyngeal  scope  (Fig.  19.35)  often  reveals  vocal  cord  injury  and  the  presence  of  petechial  hemorrhage  in  the  posterior  pharynx.  With  simultaneous  occlusion  of  both  the  carotid  and  vertebral  arteries  and  venous  systems,  it  is  possible  to  induce  fatal  and  nonfatal  strangulation  events  without  petechial  hemorrhage.  Victims  can  be  fatally  strangled  without  external  evidence  of  trauma.