Strangulation Assessment: Forensic Nursing

Strangulation is the obstruction of blood vessels and/or airway structures by external compression of the neck, and it is one of the most lethal forms of intimate partner violence. Vascular occlusion occurs at much lower forces than airway obstruction: the jugular veins are compressed at approximately 4.4 pounds of pressure, the carotid arteries at 11 pounds, and the trachea at 33 pounds. This means cerebral venous return is obstructed first while arterial inflow continues, causing rapid increase in intracranial pressure, petechiae above the level of compression (from capillary rupture), and loss of consciousness within 10-15 seconds. Continued compression leads to carotid artery intimal damage that can cause dissection and thrombosis, potentially resulting in ischemic stroke hours to days after the strangulation event. Laryngeal fracture can occur with greater force, damaging the thyroid cartilage, cricoid cartilage, or hyoid bone. Delayed complications include laryngeal edema causing airway obstruction 24-48 hours after the event, pulmonary edema from negative intrathoracic pressure generated during attempted breathing against a closed airway, and carotid artery dissection with delayed stroke. Up to 50% of strangulation victims have no...