Hanging.ppt

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Hanging.ppt

  1. 1. HangingHanging By internBy intern 朱智邦朱智邦
  2. 2. IntroductionIntroduction • About 3500 people die each year in theAbout 3500 people die each year in the United States form suicidal hanging orUnited States form suicidal hanging or strangulation.strangulation. • It’s the 3rd common form of suicide.It’s the 3rd common form of suicide. • Hanging is the most common choice forHanging is the most common choice for people who suicide successfully in recentpeople who suicide successfully in recent 10 years in Taiwan.10 years in Taiwan.
  3. 3. IntroductionIntroduction • Judicial hangingJudicial hanging – Since Biblical timeSince Biblical time – Slow strangulation with victim “Dancing”Slow strangulation with victim “Dancing” – ““Clean and instantaneous”Clean and instantaneous” • Thickness of ropeThickness of rope • Position of the knotPosition of the knot • Length of dropLength of drop – Not performed in majority of countries nowNot performed in majority of countries now
  4. 4. Classification of hangingClassification of hanging • Non-judicial vs JudicialNon-judicial vs Judicial • Suicide, homicide and accidentalSuicide, homicide and accidental – Suicidal: Most common, Male:Female=3:1Suicidal: Most common, Male:Female=3:1 – Homicide: RareHomicide: Rare – Accidental:Most common in childhoodAccidental:Most common in childhood • Autoerotic hangingAutoerotic hanging • Complete vs IncompleteComplete vs Incomplete • Typical vs atypicalTypical vs atypical
  5. 5. Clinical Feature of HangingClinical Feature of Hanging • Clinical featureClinical feature – Hemorrhage in area of ligatureHemorrhage in area of ligature – Brownish groove in the neckBrownish groove in the neck – Hoarseness and stridorHoarseness and stridor – Pain on swallowingPain on swallowing – Subconjunctival hemorrhageSubconjunctival hemorrhage – Tardieu’s spotTardieu’s spot
  6. 6. The mechanism of hanging deathThe mechanism of hanging death • Airway compression?Airway compression? – How about victim with tracheostomyHow about victim with tracheostomy – Vomitus in the airway of hanging victimVomitus in the airway of hanging victim • Cervical fracture with spinal cord transection?Cervical fracture with spinal cord transection? – Believed to be the main reason of judicial hanging.Believed to be the main reason of judicial hanging. – Few victim has cervical fracture in autopsyFew victim has cervical fracture in autopsy – Hanging on the bed?Hanging on the bed?
  7. 7. The mechanism of hanging deathThe mechanism of hanging death • DecapitationDecapitation – Cases reported in extreme situation: heavyCases reported in extreme situation: heavy body, inelastic/thin rope, fall from greatbody, inelastic/thin rope, fall from great distance.distance. • Hyperactive parasympathetic/sympatheticHyperactive parasympathetic/sympathetic nerve by carotid compression?nerve by carotid compression? – Hypothesis that has been proposedHypothesis that has been proposed
  8. 8. The mechanism of hanging deathThe mechanism of hanging death • Vascular compression with brain asphyxiaVascular compression with brain asphyxia • Believed to be the main mechanismBelieved to be the main mechanism – VesselsVessels • Internal jugular vein(2kg)Internal jugular vein(2kg) • Common carotid artery(5kg)Common carotid artery(5kg) • Vertebral artery(30kg)Vertebral artery(30kg) • Collateral circulationCollateral circulation • (Trachea 15kg)(Trachea 15kg)
  9. 9. Related Anatomy of HangingRelated Anatomy of Hanging • (past the atlas)(past the atlas)
  10. 10. Human experimentHuman experiment • Acute obliteration of neck circulation withAcute obliteration of neck circulation with 600mmHg cuff (part I)600mmHg cuff (part I) – Blurring of visionBlurring of vision – Constriction of visual fieldsConstriction of visual fields – Loss of conscious (6-6.5 sec)Loss of conscious (6-6.5 sec) – Hypoxic convulsionHypoxic convulsion – EKG minimal changeEKG minimal change
  11. 11. Human experimentHuman experiment • Prolonged occlusion of cerebral circulationProlonged occlusion of cerebral circulation up to 100 sec.up to 100 sec. – Convulsion,Cyanosis, Involuntary urination,Convulsion,Cyanosis, Involuntary urination, Involuntary defection,Involuntary defection, – Bradycardia and dilation of pupils occurredBradycardia and dilation of pupils occurred after loss of consciousnessafter loss of consciousness
  12. 12. Pathophysiology of HangingPathophysiology of Hanging Neck pressureNeck pressure ⇓⇓ Venous obstruction(stasis hypoxia)Venous obstruction(stasis hypoxia) Common carotid artery obstruction?Common carotid artery obstruction? ⇓⇓ Loss of consciousnessLoss of consciousness ⇓⇓ Decreased neck muscle toneDecreased neck muscle tone ⇓⇓ Vetebral and common carotid artery obstructionVetebral and common carotid artery obstruction ⇓⇓ DEATHDEATH
  13. 13. Complication of hanging patientComplication of hanging patient • LaryngealLaryngeal – Fracture of larynx(9%)Fracture of larynx(9%) – Soft tissue edemaSoft tissue edema • Stridor, hoaresness, dysphagiaStridor, hoaresness, dysphagia • PulmonaryPulmonary – BronchopneumoniaBronchopneumonia – Lung edemaLung edema – ARDSARDS
  14. 14. Complication of hanging patientComplication of hanging patient • NeurologicalNeurological – Delayed neurological damage?Delayed neurological damage? • Bilateral basal ganglia damageBilateral basal ganglia damage – Reperfusion injury?Reperfusion injury? – Excessive catecholamine or amino acid?Excessive catecholamine or amino acid? – Calcium?Calcium? – Korsakoff syndrome, progressive dementiaKorsakoff syndrome, progressive dementia – AmnesiaAmnesia – Accessory nerve injuryAccessory nerve injury • OthersOthers – Thrombosis of cervical artery?Thrombosis of cervical artery? • intimal and media injury in neck artery has been reportedintimal and media injury in neck artery has been reported
  15. 15. PrognosisPrognosis • Unpredictable!!!!!Unpredictable!!!!! – Risk factors identified in pediatric studyRisk factors identified in pediatric study • Failed to resume heartbeat an drespiration withFailed to resume heartbeat an drespiration with administration of first aidadministration of first aid • Apneic or had agonal respiration in ERApneic or had agonal respiration in ER • Initial pH less than 7.2Initial pH less than 7.2 • Required ventilatorRequired ventilator
  16. 16. ManagementManagement • ABCABC – Aggressive airway management is essentialAggressive airway management is essential • Most delayed mortality result from pulmonary complication!!!Most delayed mortality result from pulmonary complication!!! – Sympathomimetics and judicious use of fluid forSympathomimetics and judicious use of fluid for hypotensionhypotension – Cardiac arrhythmia be identified and treatedCardiac arrhythmia be identified and treated – Treat IICPTreat IICP • Other investigationOther investigation – X-ray of neckX-ray of neck • Observe in hospital at least 24 hoursObserve in hospital at least 24 hours
  17. 17. ManagementManagement • Potential useful drugPotential useful drug – Phenytoin?Phenytoin? • Reduce the chance of seizureReduce the chance of seizure • Has been shown helpful in arresting the development ofHas been shown helpful in arresting the development of centroneurogenic ARDScentroneurogenic ARDS – NaloxoneNaloxone • Reverse the signs of cerebrovascular ischemia in animalReverse the signs of cerebrovascular ischemia in animal modelmodel – Calcium channel blockerCalcium channel blocker – Barbiturate and steroid: controversialBarbiturate and steroid: controversial
  18. 18. Thank for your attentionThank for your attention
  19. 19. ReferenceReference • Strangulation: A Review of ligature, Manual and PosturalStrangulation: A Review of ligature, Manual and Postural Neck Compression Injuries-Neck Compression Injuries- Annals of Emergency Medicine MarchAnnals of Emergency Medicine March 1984;13:179-1851984;13:179-185 • Hanging and Strangulation Injuries-Hanging and Strangulation Injuries- The Clinical Practice ofThe Clinical Practice of Emergency Medicine,2nd edition by Harwood-Nuss etc. 566-567Emergency Medicine,2nd edition by Harwood-Nuss etc. 566-567 • Asphyxia-Asphyxia- Forensic Pathology, 2nd edition by DiMaio etc.229-277Forensic Pathology, 2nd edition by DiMaio etc.229-277 • Delayed death after attempted suicide by hanging-Delayed death after attempted suicide by hanging- Int. J.Int. J. Legal Med.1997;110:164-66Legal Med.1997;110:164-66 • The neuropsychological sequelae of attemptedThe neuropsychological sequelae of attempted hanging-J.hanging-J. of Neurology, Neurosurgery and Psychiatry.1991;54:546-88of Neurology, Neurosurgery and Psychiatry.1991;54:546-88

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