Thyroid storm following suicide attempt by hanging.

Summary A 19-year-old woman with asphyxiation complicated by cardiac arrest, following an unsuccessful suicide attempt by hanging, developed an uncommon complication of trauma-induced thyroid storm. She was initially admitted to the intensive care unit intubated and mechanically ventilated for postcardiac arrest management. Investigation of thyroid storm was pursued after the patient was noted to be persistently hypertensive, tachycardic and agitated despite high levels of sedation. Thyroid function tests confirmed the clinical suspicion of progressive thyrotoxicosis, with associated imaging consistent with thyroid inflammation secondary to band-like traumatic pressure to the lower half of the thyroid gland. Treatment with ß-blockers and a thionamide resulted in the eventual resolution of her thyroid storm state and normalisation of her thyroid function. We conclude that traumatically induced thyroid storm should be considered in all hypermetabolic patients following blunt neck injuries including hanging, and that traditional treatment of hyperthyroidism can be successfully applied.

Uneventful recovery from suicidal hanging: a case report.

Although hanging accounts for a considerable number of suicidal deaths in Sri Lanka, on rare occasions the victims survive. A few cases have been reported in the literature where victims survived after varying periods of unconsciousness. It has been observed that death does not necessarily result from hanging, provided the victim is brought down promptly and resuscitated actively and vigorously. This paper focuses on an unusual case of a 39-year-old male who survived after resuscitation, without any adverse neurological outcome, after a suicide attempt by hanging.

Patterns of injury and functional outcome after hanging: analysis of the National Trauma Data Bank.

PURPOSE: Hanging has become the second most common method of attempted suicide among adolescents, but there is little relevant epidemiologic or outcome data in the trauma literature. Additionally, there are no studies examining the degree of functional disability among survivors of hanging injury. METHODS: The National Trauma Data Bank was queried for all patients with an E-code diagnosis of hanging injury. Demographic and injury pattern data were analyzed. Disability at discharge was assessed using the functional independence measure (FIM) scores for feeding, locomotion, and expression (range 1 = full disability to 4 = no disability). Univariate and multivariate analysis was performed to identify independent predictors of mortality and degree of functional disability at discharge. RESULTS: There were 655 patients identified (84% male) with a mean age of 30.3 years and mean injury severity score (ISS) of 9. There were 92 (14%) deaths in the emergency department (ED) and 119 (18%) deaths after admission, for an overall mortality rate of 33%. Excluding ED deaths, survivors had significantly higher Glasgow coma scores (GCS) at the scene (8 vs. 4) and in the ED (9 vs. 3), a lower ED base deficit (4 vs. 9), and lower ISS (6 vs. 15, all P < .01) compared with nonsurvivors. The strongest independent predictor of hospital mortality was ED GCS <15 (odds ratio 16.1, P < .01); the mortality rate was 1.5% for patients with an ED GCS of 15 versus 29% for any GCS <15. Of patients who survived to discharge (n = 277), 84% were functionally independent (total FIM = 12), and 10% had severe functional disabilities in feeding, expression, or locomotion (FIM <3). Patients with severe disability had a higher incidence of intracranial (38% vs. 19%) and chest injury (19% vs. 5%) but surprisingly demonstrated equivalent rates of vascular (0% vs. 2.6%) and spinal injury (11% vs. 12%) compared with those without severe disability. Independent predictors of functional outcome were ISS and ED GCS (both P < .01). There was no severe functional disability at discharge among patients with an ED GCS of 15 compared with a 15% severe disability rate if the ED GCS was <15. CONCLUSIONS: Hanging injuries are associated with a high overall mortality rate, with the admission GCS being the best independent predictor of outcome. However, the majority of survivors have little to no functional disability. The presence of severe disability at discharge is mainly attributed to intracranial and thoracic injury.