Strangulation

  • Strangulation is life-threatening and requires close patient monitoring.
  • Assess all patients for strangulation. Some patients will not disclose strangulation unless directly asked.
  • Consider strangulation protocol questions. https://www.forensicnurses.org/page/STAssessment
  • Ask questions such as, “Did anything happen to your neck?
  • Notify the treating physician if the patient was strangled.
  • Non-fatal strangulation can occur in sexual assault and other forms of interpersonal violence.
  • Depending on the force applied and length of time applied, the survivor may experience temporary to severe permanent injury, even death.
  • Women are more likely to be victimized than men.
  • The pediatric population may experience strangulation during sexual assault or abuse. Children should be assessed for strangulation.
  • Strangulation is defined as external pressure to the neck, compressing blood vessels and air passages and deprivation of oxygen. It may result in carotid artery dissection, stroke, seizure, respiratory failure and death.
  • Strangulation can increase risk for post-traumatic stress disorder, anxiety and depression.
  • Use correct terminology in your documentation — “strangulation,” not “choking” (which is internal restriction of the trachea). However, patients might use the term “choking” (document their own words).
  • Ask trauma-informed, patient-centered questions such as:
    • How often, if you know, did it occur? How long did each time last?
    • When this happened, were you able to talk? Breathe?
    • Has your voice changed since the strangulation incident? Hoarse? Scratchy? Clearing throat often? Sore?
    • What part of their body did they use to strangle you?
    • Do you remember the entire event? If the patient does not remember part of the event, or is not sure, assume they lost consciousness.
    • While you were being strangled, did you lose control of your body functions (i.e., urinate or defecate)?
    • Describe what you were feeling? Seeing? Hearing? Tasting?
    • Describe pressure on a scale of one to ten.
  • Also evaluate for signs of head trauma. Notify treating physician if signs of head trauma.
  • Know the signs and symptoms of strangulation. Assess for marks and swelling of the neck, and petechiae in the sclera, roof of mouth, face, behind ears and pinna and scalp. Ask about memory loss, extremity weakness, difficulty speaking, urination, defecation, dizziness, headaches, vomiting, ringing in the ears, voice changes and difficulty breathing (Strangulation Institute, 2019).
  • Describe injuries.
  • Photo-document injuries, if possible.
  • See the Training Institute on Strangulation Prevention (2017a, 2017b) for a documentation protocol.
  • Training Institute on Strangulation Prevention imaging guidelines
  • Strangulation Protocol
  • Strangulation Signs and Symptoms (adults)
  • Strangulation Signs and Symptoms (pediatrics)