Save a Life, Ask the Question ‘Have You Been Strangled or Choked?’

Non-fatal strangulation is a serious but often overlooked condition in the emergency department. Emergency nurses need to know the principles of the violent act so they are better able to identify and treat it in their emergency departments.

Frequently patients present to the ED with minor and non-specific signs and symptoms that can be easily attributed to other causes. This can be deceiving and might be minimized by first responders and ED staff.

In a Wednesday session, titled “The Edge of Death: Principles of Non-Fatal Strangulation Every ED Nurse Should Know,” Joyce Foresman Capuzzi identified some of these principles to help attendees better understand the nuances of the condition.

Joyce Foresman Capuzzi

“Strangulation is the last violent act before homicide,” Capuzzi said, adding that 90 percent of strangulation cases accompany a history of prior intimate partner violence.

Patients who experience even one episode of IPV, she said, have a 68 percent chance of being strangled at some point.

Capuzzi said ED nurses must be especially vigilant in assessing for elusive signs and symptoms of non-fatal strangulation as well as directly asking patients about strangulation. She underscored the fact that the signs and symptoms of strangulation can be hard to spot. In fact, less than 50 percent of strangled patients who present to the ED have visible signs of the event.

“Just because we don’t see something doesn’t mean something didn’t happen,” Capuzzi said. “At the same time, no one sign or symptom will point to nonfatal strangulation.”

She highlighted various signs emergency nurses can look for, such as wounds to the neck, mouth or eyes, as well as gastrointestinal, respiratory and neurological problems. She also pointed out symptoms the patient may have, including neck pain, voice changes or swallowing variations.

Other topics covered during the session included the types of strangulation, delayed injuries to watch out for, pediatric strangulation, documentation, and the importance of effective forensic testing.