First aid - hanging
David Kříž
Learning objectives
̶ Student will learn first aid for hanging.
̶ Student will learn about the consequences of strangulation injury.
̶ Student will learn the irreversible signs of death.
Hanging
̶ Hanging is the most common method for suicide.
̶ Approximately 1400 suicides per year in the Czech Republic (60%
by hanging).
̶ Reduced air flow and/or blood flow to or from the brain via the
intentional external compression (rope) of blood vessels or the
airway in the neck.
̶ Only about 5 kg is sufficient to successfully hang by suffocation,
so it is also possible to hang a knee or even lie down.
̶ The self-weight of the affected person will result in typical injuries
leading to death. Noticeable strangulation groove
Suspension hanging will kill the person in
many ways:
̶ Compression of the carotid arteries
̶ Compression of the jugular veins
̶ Compression of the airways.
̶ Dislocation/ fracture of the cervical spine > neck injury >paralysis
of the respiratory muscles.
̶ Irritation of the nervus vagus (arrhythmia, erection, defecation).
https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.forensicnurses.org%2Fpage%2FSTAssessment&psig=AOvVaw24v8Zkc2i1cG6ABCCocu2F&ust=1596639825605000&source=images&cd=vfe&ved=0CAIQjRxqFwoTCICT0
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Signs/symptoms
 Choking / cardiac arrest / signs of death.
 Congestion of the face and neck. Redness, blood-red eyes.
 Conjunctiva-petechiae (pinpoint hemorrhages).
 Strangulation object - rope. Ligature marks ("rope burns")
 Cyanosis (ears, nose, lips)
 External signs of violence (bruising, abrasions, strangulation
groove)
https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.jems.com%2F2015%2F12%2F22%2Finitial-findings-in-strangulation-injury-aren-t-indicative-of-
outcome%2F&psig=AOvVaw0XOKeXYmBHusXBDiqbQngR&ust=1596640985653000&source=images&cd=vfe&ved=0CAIQjRxqFwoTCJDWiKjtgesCFQAAAAAdAAAAABAE
First aid
̶ Call for help.
̶ Loosening the strangulation object-rope. Put the victim on the back.
̶Urgent CPR where there are no signs of death or one of the vital
functions is still maintained.
̶In case of restitution of spontaneous circulation and breathing.
Transport patients to the hospital.
̶In the case of attempted hanging, always ensure immobilization of
the cervical spine during transport.
̶https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.emergency-live.com%2Fcs%2Fambulance%2F10-kroky-k-proveden%25C3%25AD-spr%25C3%25A1vn%25C3%25A9-spin%25
Irreversible signs of death
̶ Post mortem staining.
̶ Post mortem lividity.
̶ Pos mortem stiffness (rigor mortis)
̶ Pallor mortis - pale skin.
̶ In case of irreversible signs of death, CPR is not started.
̶ CAVE: If not sure, always start CPR!
https://www.google.com/url?sa=i&url=https%3A%2F%2Fis.cuni.cz%2Fwebapps%2Fzzp%2Fdownload%2F140014774&psig=AOvVaw3yFNKaqYiJwbkSgwPh_qkD&ust=1596641884022000&source=images&cd=vfe&ved=0CAIQjRxqFwo
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Learning outcomes
̶ Student can explain the principles of first aid for hanging.
̶ Student can explain the mechanism of injury when hanging.
̶ Student lists irreversible signs of death.
References
̶ ↑ https://www.czso.cz/csu/czso/sebevrazdy_zaj
̶ ↑ UNKNOWN. Small Medical Revue [online]. 2013-07-03 [cit. 2019-04-22]. Dostupné online.
̶ ↑ DRAHOTA, Leoš. Naše šibenice 16 - Novodobé věšení [online]. Moskyt. Geograficko Badatelský
Magazín, 11.07.2008 [cit. 2017-04-11]. Dostupné online.
̶ ↑ Milada Horáková umírala čtvrt hodiny, zjistili historici. iDNES.cz [online]. 2005-06-29 [cit. 2019-04-22].
Dostupné online.
̶ ↑ Poslední tajemství Slánského smrti. iDNES.cz [online]. 2003-04-17 [cit. 2019-04-22]. Dostupné
online.
̶ ↑ "Modern-day 'outlaws' gather to honour Jánošík". The Slovak Spectator. July 9, 2012.
Simulation Centre, Faculty of Medicine, Masaryk University
2020