Strangulation. First emergency pre-medical and medical care for asphyxiation.

Strangulation occurs with mechanical compression of the neck and, accordingly, the respiratory tract. It can be complete (in case of loss of support) or incomplete (support remains). Most often strangulation occurs when hanging (intentionally or in an accident). 

Strangulation. First emergency first aid and medical care for asphyxiation.

After losing support, the loop on the neck is tightened under the weight of the body. Strangulation can occur when tightening the loop around the neck. The material from which the loop is made affects the severity of damage to the soft tissues of the neck. The harder it is, the more severe the damage is. In more rare cases, strangulation is associated with other objects, such as large bifurcated tree branches. In young children, asphyxiation can occur when the head is accidentally fixed in the lattice of the headboard of the bed or chair, when the neck and head are entangled with a clothes belt, beads, ropes from suspended toys.

When suffocation not only stops the flow of air into the body, but also injuries of the soft tissues and organs (larynx, trachea) of the neck, cervical spine, and cervical segment of the spinal cord occur. It is also damaged in the lower part of the brain stem. The risk group for asphyxiation includes children under 1.5 years of age, as well as adolescents and people 30-40 years old, prone to depression and dangerous sexual games.

When strangulation on the neck, characteristic signs are noted – a groove, hemorrhages in the form of a strip, traces from asphyxiating objects. The victim, when quickly detected, may be in a consciousness or coma. Edema of the soft tissues and extensive hemorrhages can lead to neck deformation. Often, asphyxiation on the scalp and conjunctiva, small-pointed hemorrhages are noticeable. If the victim is conscious, then he complains of shortness of breath, pain when swallowing and feeling the neck. Often there are changes in the voice (hoarseness), disturbances in swallowing, a long whistling whistle, blood secretion from the respiratory tract.

Damage to the muscles of the neck and cervical spine are manifested by the forced position of the head, pain in the neck, restriction or complete lack of mobility of the head and neck. In case of damage to the cervical segment of the spinal cord, neurological symptoms appear: full and partial paralysis of all limbs, the absence of sensitivity in the body and the trunk. There may be respiratory disorders, impaired consciousness. Damage to brain structures leads to loss of consciousness and coma. In this case, the functions of the respiratory and cardiovascular systems are impaired. Paralysis of the muscles of the soft palate, tongue, epiglottis and voice.

There is no sensitivity in the soft palate, nasopharynx, larynx and trachea. If the patient is still conscious, then his speech has a nasal sound, disorders in pronouncing sounds are detected, his voice changes and swallowing is disturbed. Sometimes strangulation is accompanied by vomiting in the respiratory tract. In this case, the patient’s breathing is shallow, frequent, the skin is bluish, there are multiple wet rales in the lungs and a significant decrease in blood pressure. Dying with asphyxiation occurs very quickly, within a few minutes. The absence of air into the lungs for 7-8 minutes is fatal.

First, the victim is conscious, he has frequent and deep breathing, in which the auxiliary muscles participate, and the skin becomes bluish. The pulse is frequent, and arterial and venous pressure rises. Then there is a loss of consciousness, convulsions and relaxation of the sphincters occur. The latter leads to involuntary urination and bowel movements. Breathing becomes irregular and rare. Then an agonal state develops, and clinical death occurs.

The effectiveness of resuscitation depends not only on the duration of strangulation, the severity of damage to the neck and its organs, but also on the location of the suffocating groove. More severe damage is associated with a loop closure on the back of the neck. If the loop closes on the front or side of the neck, then the damage is less severe. The location of the choking groove above the larynx leads to a very quick stop of cardiac activity and respiration. At the same time, the outflow of venous blood from the skull is disturbed, intracranial pressure rises and oxygen starvation of the brain develops. When the choking groove is located below the larynx, these processes develop more slowly, and in some cases self-rescue is possible.

After the restoration of air supply to the lungs, the victim has signs of damage to the central nervous system (pronounced motor excitement, increased muscle tone, cramps). The skin of the face and neck is cyanotic, on it and the mucous membranes there may be small-pointed hemorrhages. Irregular breathing, frequent; significant increased heart rate, increased blood pressure. Spinal fractures associated with a fall are often noted. Consideration should be given to increased blood coagulation during asphyxiation..

First emergency first aid and medical care for asphyxiation.

The victim needs emergency resuscitation. First of all, it is necessary to free the neck from the loop, but with the preservation of the node. Why do you need to cut the rope. With prolonged asphyxiation, this is impractical. If the strangulation is incomplete and the victim is still alive, then resuscitation can be successfully carried out within 5 minutes. After releasing the neck, it is necessary to lay the victim on a solid horizontal surface, if possible, immobilize the neck with a special tire – an improvised cardboard collar. Next, you should evaluate the state of the cardiovascular and respiratory systems. In the absence of breathing and palpitations, it is necessary to start restoring the airway and resuscitation.

Swelling of the neck, cartilage fractures can make it difficult to carry out artificial respiration. In this case, a breathing tube must be inserted into the trachea or a tracheostomy performed. If necessary, then carry out hardware artificial ventilation of the lungs. It is necessary to constantly monitor the victim, as it is possible leakage of the contents of the stomach or ingestion of vomit in the respiratory tract. To eliminate seizures, 2 ml of a 0.5% solution of diazepam are injected intravenously or intramuscularly or 5-10 ml of a 20% solution of sodium hydroxybutyrate.

Transportation of the victim to the hospital is mandatory and is carried out on a hard stretcher. If it lies on a shield, a wide board, then it is not recommended to transfer it to a stretcher. If possible, oxygen inhalations should be given. To normalize the acidic ground state, 200 ml of a 4% solution of sodium bicarbonate are dripped into a vein. Given the increase in blood coagulability, 1 ml of heparin (5000 IU) is administered intravenously or subcutaneously to improve blood circulation and prevent thrombosis. To eliminate edema, if necessary, 40-60 mg of furosemide, 5-10 ml of a 2.4% solution of aminophylline or 30-60 mg of prednisolone are administered.

Based on Quick Help in Emergencies.
Kashin S.P..

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