Strangulation refers to external pressure applied to the neck, distinct from internal choking caused by an object blocking the airway. It is a serious, life-threatening event that compromises blood vessels or the airway, rapidly reducing oxygen supply to the brain. The health risks are substantial, demanding an urgent response, even if external injuries appear minimal or absent. Strangulation requires a specific medical and legal response due to its severity as a form of assault.
Immediate Self-Care and Safety Actions
Following a strangulation event, the immediate priority is ensuring safety and stabilizing breathing. If possible, remove yourself from the source of harm and move to a secure location immediately.
Immediately assess your breathing and ability to speak, as internal swelling can rapidly obstruct the airway. Try to remain calm to conserve oxygen and minimize strain on neck structures. Call emergency services immediately, or ask a trusted person nearby to do so, explaining that you experienced pressure to the neck.
Limit movement of your head and neck until medical professionals can assess you. If you are still in danger, tuck your chin down and raise your shoulders slightly (the “turtle shell technique”) to help protect the airway. Seek medical attention immediately, even if you feel fine, as severe, unseen injuries may be present.
Recognizing Delayed and Internal Injuries
The most concerning aspect of strangulation is the risk of internal injuries that may not show symptoms for hours or days later. Only about half of victims have visible external signs of injury, and even fewer have marks significant enough to photograph. This absence of visible injury often leads to the seriousness of the event being underestimated by both the victim and initial responders.
One of the most dangerous complications is Carotid Artery Dissection (CAD) or vertebral artery injury, involving a tear in the inner lining of blood vessels supplying the brain. This damage can lead to a blood clot traveling to the brain, causing an ischemic stroke days or weeks after the assault. Symptoms of a developing stroke, such as facial weakness, arm weakness, or difficulty speaking, must be recognized as a medical emergency.
Soft tissue damage within the throat and neck is common and may worsen over time. Difficulty swallowing (dysphagia), a persistent sore throat, or a change in voice quality can indicate injury to the larynx or trachea. Delayed swelling in the airway can lead to difficulty breathing up to 36 hours after the event, potentially causing fatal obstruction.
Neurological symptoms stem from temporary or prolonged cerebral hypoxia (reduced oxygen to the brain). These can manifest as confusion, memory loss, agitation, or a sense of impending death experienced during the event. Even temporary oxygen deprivation can result in long-term cognitive issues like poor concentration or difficulty with executive functions.
Essential Medical Evaluation and Follow-up
All individuals who have experienced external pressure to the neck must undergo an immediate medical evaluation at an emergency department, regardless of how they feel. Healthcare professionals will conduct a detailed physical examination, focusing on the airway, neck tenderness, and neurological status. They will look for subtle signs of vascular injury, such as a bruit (an abnormal sound over the carotid arteries) or small pinpoint red spots called petechiae on the face or eyes.
Standard diagnostic imaging is necessary to rule out unseen vascular and soft tissue damage. Computed Tomography Angiography (CTA) of the neck is often the preferred method for assessing the carotid and vertebral arteries for dissection or other cerebrovascular injuries. A CT scan of the brain may also be performed to identify cerebral edema or signs of stroke.
The medical team may use nasendoscopy, where a flexible tube examines the larynx and vocal cords for bruising and swelling. Due to the risk of delayed complications, a period of medical monitoring is often required. Patients are advised to have a responsible adult stay with them and monitor for new or worsening symptoms for at least 24 to 72 hours after the event.
Documentation, Reporting, and Psychological Support
Documentation of the event and injuries is important for both legal and medical follow-up. If safe, photograph any visible injuries (petechiae, bruising, or scratches), as these marks fade quickly. Save any clothing worn during the assault without washing it to preserve forensic evidence.
Writing a detailed account of the event, including the date, time, and specific actions, is helpful since memory loss or confusion is common. This documentation creates a clearer medical and legal record. Forensic nurse examiners are often available in emergency departments to provide specialized treatment and evidence collection.
Psychological Support
Strangulation is a highly traumatic experience that can lead to significant psychological injury, including Post-Traumatic Stress Disorder (PTSD), severe anxiety, and depression. Survivors often report intense fear and a feeling of being close to death, contributing to long-term mental health challenges.
Seeking mental health support is a crucial part of recovery; resources include trauma-informed therapy, crisis hotlines, and victim support services. If the strangulation occurred during intimate partner violence, understand that this action significantly increases the risk of future homicide. Accessing resources focused on safety planning and risk assessment is strongly advised.