Approach considerations for the management of strangulation in the emergency department.

Patients with a history of strangulation present to the emergency department with a variety of different circumstances and injury patterns. We review the terminology, pathophysiology, evaluation, management, and special considerations for strangulation injuries, including an overview of forensic considerations and legal framework for strangulation events.

Nurturing Hope and Well-Being Among Survivors of Domestic Violence Within the Family Justice Center Model.

Family Justice Centers (FJCs) represent a multi-disciplinary coordinated approach co-located to serve survivors of domestic violence. This study examined the change in hope and well-being among 130 survivors receiving domestic violence services through seven FJCs. Using a pretest, posttest design, Analyses of Variance results indicated that survivors exhibited robust increases in hope, emotional well-being, and flourishing. Correlational analyses showed that survivor defined goal success has important relationships with hope and well-being. Finally, hierarchical regression analyses revealed hope contributed unique variance of survivor flourishing over-and-above survivor defined success and emotional well-being. These findings are discussed in the context that hope may be an important coping resource for survivors of domestic violence and offers a common conceptual framework for FJCs.

Recognition and Documentation of Strangulation Crimes: A Review.

IMPORTANCE: Strangulation accounts for 10% of violent deaths in the United States and 15% to 20% of deaths associated with domestic violence. However, strangulation deaths represent only a small fraction of nonfatal strangulation assaults, which occur with daily frequency in medium to large US cities. Careful evaluation and documentation of strangulation injuries may identify life-threatening medical conditions, and may facilitate prosecution of strangulation crimes. OBSERVATIONS: The most recent article on strangulation identified in the otolaryngology literature was published in 1989, leaving a generation of head and neck surgeons without current guidance regarding this injury. However, strangulation is a common form of intimate partner violence. Among the 300 cases of strangulation reviewed in San Diego in 1995, most survivors (94%) were women who were strangled by a male member of their own household. Many state laws require evidence of injury to prosecute felony strangulation, but as shown in the review of 300 cases, most survivors (97%) were strangled with the perpetrator's hands, leaving little to no sign of injury in most cases. Survivors may seek an otolaryngology consultation with complaints of hoarseness, sore throat, respiratory disturbance, or accidental injury to the neck. A thorough head and neck examination may reveal marks on the neck, facial petechiae, and neck swelling. Fiberoptic laryngoscopy is recommended to look for petechiae and swelling in the airway. Chest radiographs may demonstrate postobstructive edema, and computed tomography of the neck may demonstrate vascular injuries. The most sensitive test for subtle strangulation injuries is magnetic imaging of the neck. Careful examination and documentation can provide critical evidence for the prosecution of these crimes. CONCLUSIONS AND RELEVANCE: Otolaryngologists should be knowledgeable of the subtle patterns of injury and potentially life-threatening complications of strangulation and should consider domestic violence in women presenting with throat complaints or bruises on the neck.

Strangulation forensic examination: best practice for health care providers.

Strangulation is one of the most dangerous forms of interpersonal violence (IVP), yet it is often not reported and missed by the health care provider because of lack of visible injury. The victim of strangulation can have critical injuries and a late onset symptoms. Victims of IVP should be directly asked whether they were choked or whether during the assault they felt like they could not breathe because of pressure on their neck. The objective of this article is to summarize "best practice" for health care providers so that they are better prepared to care for victims who report a history of strangulation. A summary of how to perform a forensic examination of the strangled patient is provided along with important documentation takeaways and useful forms to ensure that the severity of the strangulation is assessed, that critical injuries are identified, and that all injuries and findings are accurately documented for legal proceedings.

Domestic violence: no place for a smile.

Because dentists routinely assess a patient's head, neck and mouth, they have a unique and excellent opportunity to recognize whether or not a patient is being abused. This article seeks to enlist the collaboration of the dental community in the effort to prevent domestic/intimate partner violence and provide more information about the signs and symptoms of domestic violence injuries, including strangulation, which is often overlooked by medical and dental professionals. Strangulation has only been identified in recent years as one of the most lethal forms of domestic violence. Unconsciousness may occur within seconds and death within minutes. It is known that victims may have no visible injuries whatsoever yet because of underlying brain damage by a lack of oxygen from being strangled, victims may have many serious internal injuries or die days or several weeks later. Strangulation is often indicative of a high level of domestic violence in a relationship. Attempted strangulation may cause physiological changes evident in the course of a dental examination. For these reasons, dentists should be vigilant in looking for its symptoms.