I'll start off the month with a POTD inspired by a case from the other day… 36 yo M bib NYPD after he was found passed out in a jail cell after being arraigned with a ligature mark around his neck…He wound up being ok and was transferred out for inpatient psych but lets talk hanging injuries…
CLASSIFICATION:
EVALUATION:
- ABCs but of course!! Low threshold to intubate for airway protection as they can crash without warning!!
- Look for pain to larynx, cough, stridor, muffled voice, resp distress, AMS, petechiae, abrasions/lacerations/contusions to neck and hard/soft signs of vascular injury
- High risk of ARDS and cerebral edema so judicious fluids- don’t go flooding them!
- Altered? Tube and treat for increased ICP
- High risk of arrhythmias
IMAGING: CT brain (cerrebal hypoxia), CT c-spine (mc= c2 spondylolithesis) and consider CTA head/neck for vascular injury!
DISPO:
- ALL should be admitted for 24hr obs as high risk for delayed airway and pulmonary complications
Sources:
Life in the Fast Lane. http://lifeinthefastlane.com/trauma-tribulation-016/
EM-Docs
Medscape, UpToDate