Judah
Enlightened
- Oct 1, 2020
- 1,531
Note: Most of the links in this post are from the Wayback Machine, which is convenient at the same time, so I recommend seeing the direct links by removing the Wayback Machine url manually
Suicidal hanging is the act of fully or partially suspending one's body with the help of a ligature such that the body weight causes certain parts of the body to press against the ligature, resulting in death. This article discusses the most widely encountered form of hanging, in which parts of the neck are compressed.
Simple, step-by-step instructions
There are many ways to commit suicide by hanging. The following is an easy, quick, and pain-free guide.
The arteries deliver blood into the brain, and the jugulars drain blood from the brain. In hanging, several mechanisms of death are possible, in particular:
Direct compression of the carotid arteries leads to decrease or loss of cerebral blood flow and brain death. Compression of the jugular veins also results in acute death by causing cerebral hypoxia followed by loss of muscle tone. Once muscle tone is compromised, increased pressure is applied to both the carotid arteries and trachea. Direct pressure on the carotid sinuses causes a systemic drop in blood pressure, bradycardia, and other arrhythmias. Consequences are anoxic and hypoxic brain injury death (Dunn and Lopez, 2019), accompanied by abnormal posturing.
The jugular are easy to compress. Compressing jugulars will result in too much blood flow to the brain, making your head feel like exploding. When the compression isn't enough to close the arteries (i.e., lack of enough pressure on rope), the pressure in the head builds up so much that even after death, the head is bloated and purple. (Not the way to go).
The Pressure Required to Break Different Neck Structures
Upon arrest of cerebral blood flow, a sequence of responses follow, including unconsciousness, followed by dilated pupils, tonic/clonic movements, loss of bladder and eventually bowel control, and appearance of pathological reflexes (Smith, Clayton and Robertson 2011).
Ligature type
Whatever is used should have a sufficient specified breaking strain and be static (i.e., not stretch). The width of the ligature matters. Contrary to popular belief, wider isn't more comfortable. Yes, it may be more comfortable on the skin initially, but the inability to close the arteries quickly makes it uncomfortable with the extreme head bloating. The preferred thickness is finger size or smaller. If you still want to use a belt, you can't tie the belt in knots to the doorknob, but you wedge the other end in the door jamb and close the door, as shown here[1|2]
Ligature Size and Texture
If a noose is used, the ligature should easily slide through it so it closes well, whereas the noose should not come undone easily when the force on the rope is reduced. It may also be a good idea to lubricate the ligature with soap. This would help the noose tighten even quicker, especially if you're using a rough ligature such as a rope. Lubricating it in this way will decrease the friction once you push your head down and tighten the noose, and could make it a little more effective and faster.
Knots
The rope can be attached to a round pole with a snuggle hitch.
Long-drop suspension
The aim of drop hanging, which is also frequently used in executions, is to break the neck. Participants fall vertically with a rope attached to their neck, which when taut applies a force sufficient to break the spinal cord, causing death. Unless a long drop hanging is planned, such as in drop from a bridge[1|2] or a rooftop[1|2], the hangman's knot shouldn't be used, because it causes too much friction.
As an example of long-drop suspension, consider the woman in this video[1|2|3|4]. She uses some kind of cloth and attaches it to a grid. Then, she ties the cloth around her neck and makes the jump. She hesitates shortly and pulls her feet up to stand up again but let's herself fall down again. No twitching or swinging, it's a really peaceful hanging. For the long drop or measured drop[Archive] method, generally, the knot is placed under the prisoner's left ear (the subaural position) as was seen in the photographs of Saddam Hussein[1|2].
Partial suspension
While a fixed loop[1|2] can work too, a noose would generally appear to be safer. There is absolutely no need to learn any hard complex knots. The more complex the knot is, the more friction it'll make and the harder it'll be to compress the neck. There are three possible ways to close the loop:
1- The slip knot is a frequently suggested knot, because it slides easily, can be quickly undone, and doesn't pinch.
2- Friction of slide can be reduced by using a carabiner[1|2], a metal ring[1|2], or a D-ring tied to the end of the rope.
3- Using asymmetric position of the noose (e.g., sitting on the floor[1|2], lying on the floor[1|2], or standing on a ladder[1|2]). A comfortable setups is lying on the bed[1|2|3] and using the bedframe as the anchor point for asymmetric noose, similar to hanging in lying-down position on a slope[1|2].
Knotting Tutorials
1- The best placement: As forum members have suggested, placing the rope approximately in the middle of the neck while tilting the head downwards made them passing out within seconds. The best placement of the rope is halfway between your Adam's apple and the base of your neck. Or about one to two fingers widths down from the middle of the Adam's apple. If you visually sectioned the neck into thirds, it would be the first line up from the bottom. This is the most comfortable spot. The perfect position to put the rope on are shown by ligature marks from front[1|2] and side[1|2] photos. It's easy to compress everything and pass out in about 10 seconds with no airway restriction or discomfort. By going lower from the the Adam's apple, you can use the sternocleidomastoid[1|2|3] to compress the common carotid arteries[1|2|3] by pressing it into the omohyoid[1|2|3] with the rope, while still protecting the trachea from the rope with the same muscles. The omohyoid travels deep towards the sternocleidomastoid[1|2|3], which confines the omohyoid muscle[1|2|3] in order to give it its distinctive angle, along with the deep cervical fascia. In short, carotid arteries and jugular are much easier to close off at the bottom of the neck than the top, especially in the standing or kneeling position (as shown in the diagram[1|2|3]), if you lean into it perfectly. Here[1|2] is an example of a girl who leaned backward while her head tilted forward; she could have faced the opposite direction.
2- The mediocre placement: The author of "Choosing a dignified ending" recommends placing the noose at the base of the neck, causing mild build up of pressure while avoiding irritation of the throat, which is protected by muscles at that area. It's okay to put the rope at the very base of the neck with the rope resting on the collar bones before tightening, but it's still not the recommended spot. The muscles at the base of the neck are big enough to protect the trachea, but they're too big to allow you to easily compress the arteries going to the brain.
3- The most uncomfortable placement: Placing the noose high up the neck[1|2|3] will constricts the trachea. Constricting the trachea will causes a urge to cough or a feeling of choking. Forum members have reported that putting the pressure high on the neckline above the trachea was causing them to cough and they couldn't breathe properly—because anytime they went to swallow, their trachea had to raise, but it was not possible due to trachea being blocker by the cord. Near the jaw, the carotid arteries branch on both sides. Of course, you can compress them up there, but it requires more force because one branch is deeper. This placement of the rope has a higher rate of failure due to the fact there are now 4 paths instead of 2. Not to mention it crushes your trachea.
Finding carotid artery
Place your hands behind your neck[1|2|3] as you would do when stretching. Place your thumbs left and right below your jaw and move them backwards until you reach the gap between your jawbone and throat left and right of your windpipe. You should clearly feel your pulse when applying light pressure. Now you can interlink the tips of your other fingers behind your neck—just below or partially on the end of your skull. All you need to do now is to press backwards and upwards with our thumbs (towards or below the end of your skull) with moderate force. You will go limp within 5 to 15 seconds. If you do not or feel pressure building inside your head, you are either not pressing hard enough or your thumbs are misaligned. You won't pass out but your body will go almost completely limp for few seconds, best do it while sitting or lying down.
You shouldn't do it more than one or two times a day; otherwise, you will get a headache.
Body positions
(Khokhlov, 2001) calculated the weight of suspension, in different positions[1|2], with the following results:
Kneeling[1|2] is often discouraged in favor of sitting[1|2] or standing[1|2] with legs straight, because the former is thought to make cancellation more difficult.
Required time
(Sauvageau et al., 2011) analyzed 14 filmed hangings in which rapid loss of consciousness had occurred in 10 ± 3 seconds and mild generalized convulsions in 14 ± 3 seconds. The type of suspension (partial or full), position of the partial suspension, and ethanol intoxication did not influence the timing of the agonal responses. The start of the deep abdominal respiratory abdominal movement occurred significantly faster in autoerotic practitioners (who often play for a longer period with the hanging process before the final hanging), whereas the loss of muscle tone was significantly delayed. Moreover, (Sauvageau, Ambrosi and Kelly, 2012) studied 3 nonlethal ligature strangulations, presented by an autoerotic practitioner. The loss of consciousness occurred in 11 seconds, similar to the time observed in hanging (10 ± 3 seconds). The loss of consciousness was closely followed by the onset of convulsions (7 – 11 seconds), in comparision to 14 ± 3 seconds in hanging. Later phases in hanging are decerebrate rigidity at 19 ± 5 seconds, start of the very deep respiratory attempt at 19 ± 5 seconds, decorticate rigidity at 38 ± 15 seconds, loss of muscle tone at 1 minute 17 seconds ± 25 seconds, end of the very deep respiratory attempt at 1 minute 51 seconds ± 30 seconds, and last muscle movement at 4 minutes 12 seconds ± 2 minutes 29 seconds.
(Sauvageau, LaHarpe and Geberth, 2010) analyzed agonal sequences eight filmed hangings. Rapid loss of consciousness was observed (at 8 – 18 sec), closely followed by convul-ions (at 10 – 19 sec). As for the respiratory responses, all cases presented deep rhythmic abdominal respiratory movements (last one between 1 min 2 sec and 2 min 5 sec).
Historically speaking, the body of executed persons in India of an executed person were kept hanging for less than half an hour (Bansal, 2005). Rare cases of survived hanging after a suspension duration of 5 – 10 minutes and up to 15 minutes (Hausmann & Betz, 1997). Except in vagal stimulation, death is not immediate in cases of hanging. It is unlikely to occur before the end of 5 minutes and may take as long as 20 minutes thus explaining how death can occur tardily in victims of mechanical asphyxia. If there is no injury to the spinal cord and the stoppage of air is not complete, 5 to 8 minutes is the typical fatal period, but it is possible that life may be restored in extremely rare cases after even 30 minutes of suspension (Kodikara, 2006).
Consequences of failure
Although survival without neurological damage is possible, a failed hanging suicide attempt may result in serious permanent disability.
Even if be saved during the attempt, death still may occur. Such cases of delayed success have been reported by Assistant coroner Anna Morris[1|2], Assistant coroner P. Harrowing[1|2], and Senior coroner Alison Mutch[1|2]. Survival in hanging depends upon many factors but it was mainly duration of suspension, early resuscitive measures and force applied for compression of neck. Time required for irreversible cerebral damage to occur is said to be variable, but consensus of opinion is that if the blood supply to brain has been cut off continuously for less than 4-5 min permanent brain damage is very unlikely (Sane, 2015).
(Amalnath, Jawaid & Subrahmanyam, 2017) and (Ribaute et al., 2019) performed statistical analysis on neurological outcomes in suicidal hanging. (Kautilya, 2011) studied the frequency of neck injuries to inner tissues with regard to the type of hanging, hanging material, position of the knot and weight of the body, in order to to indicate the mechanism of injury to the organs. (Mikellides, 2018) discussed patterns of injury. Injury mainly arises through pressure on the neck veins and arteries. The external compression causes venous cerebral congestion, hypoxic circulation, and reduced arterial cerebral supply. Pulmonary complications include pulmonary edema (ARDS) and bronchopneumonia secondary to aspiration. Thyroid cartilage fractures are the most common with fractures of the hyroid bone and cricoid cartilage seen less often. Other neurological injuries include various spinal cord syndromes, focal cerebral deficits, transient hemiparesis, and larger infractions.
Suicidal hanging is the act of fully or partially suspending one's body with the help of a ligature such that the body weight causes certain parts of the body to press against the ligature, resulting in death. This article discusses the most widely encountered form of hanging, in which parts of the neck are compressed.
Simple, step-by-step instructions
There are many ways to commit suicide by hanging. The following is an easy, quick, and pain-free guide.
- Find an anchor point.
- Tie one end of a thin ligature to the anchor point using snuggle hitch knot and make a noose using slip knot with the other end.
- Test the setup by firmly pushing the rope with your hands.
- Put the noose at halfway between your Adam's apple and the base of your neck. (If you visually sectioned the neck into thirds, it would be the first line up from the bottom.)
- Lean your body forward (not downward) and tilt your head downward.
The arteries deliver blood into the brain, and the jugulars drain blood from the brain. In hanging, several mechanisms of death are possible, in particular:
* Closing the carotid and possibly the vertebral arteries[1|2|3], significantly reducing the flow of oxygenated blood into the head → anatomy of carotid artery[1|2|3]
* Closing the jugular veins[1|2|3], preventing the outflow of deoxygenated blood from the head, leading to congestion in head blood vessels, pooling of blood in the head, and increased venous pressure and rupture of venules. Closing only jugular vains may involve the unpleasant sensation of an exploding head, popping out eyes or falling out teeth → anatomy of jugular vein[1|2|3]
* Compressing the trachea (or windpipe)[1|2|3], hurts, causes suffocation, and triggers the CO2 panic response → anatomy of thyroid[1|2|3]
Usually, the first of the aforementioned is intended: both arteries are equally occluded.Direct compression of the carotid arteries leads to decrease or loss of cerebral blood flow and brain death. Compression of the jugular veins also results in acute death by causing cerebral hypoxia followed by loss of muscle tone. Once muscle tone is compromised, increased pressure is applied to both the carotid arteries and trachea. Direct pressure on the carotid sinuses causes a systemic drop in blood pressure, bradycardia, and other arrhythmias. Consequences are anoxic and hypoxic brain injury death (Dunn and Lopez, 2019), accompanied by abnormal posturing.
The jugular are easy to compress. Compressing jugulars will result in too much blood flow to the brain, making your head feel like exploding. When the compression isn't enough to close the arteries (i.e., lack of enough pressure on rope), the pressure in the head builds up so much that even after death, the head is bloated and purple. (Not the way to go).
The Pressure Required to Break Different Neck Structures
| Anatomic neck structure | Minimum pressure to collapse |
|---|---|
| Carotid arteries | 2.5 – 10 kg (5.5 – 22 lbs) |
| Vertebral arteries | 8.2 – 30 kg (18 – 66 lbs) |
| Jugular veins | 2 kg (4.4 lbs) |
| Trachea | 15 kg (33 lbs) |
| Cricoid cartilage | 20.5 kg (45 lbs) |
Ligature type
Whatever is used should have a sufficient specified breaking strain and be static (i.e., not stretch). The width of the ligature matters. Contrary to popular belief, wider isn't more comfortable. Yes, it may be more comfortable on the skin initially, but the inability to close the arteries quickly makes it uncomfortable with the extreme head bloating. The preferred thickness is finger size or smaller. If you still want to use a belt, you can't tie the belt in knots to the doorknob, but you wedge the other end in the door jamb and close the door, as shown here[1|2]
Ligature Size and Texture
| Comfortableness tier | Examples |
|---|---|
| Excellent (experts' choice) | BDSM rope (soft cotton bondage rope)[1|2] Shibari rope (silky Japanese clothing bondage)[1|2] |
| Very good | 550lb paracord[1|2] 10 mm static rock climbing rope[1|2] |
| Good | Necktie ("soft and you can black out quickly with low pain") Extension cord[1|2] Power strip[1|2] Network cable (had taken 100 mg of Dexofen and 1500 mg of Paracetamol)[1|2|3|4] Small wires Dog leash |
| Competent | Dressing gown cord[1|2] Scarf[1|2] Handkerchief Normal belt (not a low quality one purchased at a discount store) Leather belt with prong buckle[1|2] Bathrobe belt[1|2] Martial arts belt Bed sheet[1|2] Sheet[1|2] Thick rope[1|2] |
Knots
The rope can be attached to a round pole with a snuggle hitch.
Long-drop suspension
The aim of drop hanging, which is also frequently used in executions, is to break the neck. Participants fall vertically with a rope attached to their neck, which when taut applies a force sufficient to break the spinal cord, causing death. Unless a long drop hanging is planned, such as in drop from a bridge[1|2] or a rooftop[1|2], the hangman's knot shouldn't be used, because it causes too much friction.
As an example of long-drop suspension, consider the woman in this video[1|2|3|4]. She uses some kind of cloth and attaches it to a grid. Then, she ties the cloth around her neck and makes the jump. She hesitates shortly and pulls her feet up to stand up again but let's herself fall down again. No twitching or swinging, it's a really peaceful hanging. For the long drop or measured drop[Archive] method, generally, the knot is placed under the prisoner's left ear (the subaural position) as was seen in the photographs of Saddam Hussein[1|2].
Partial suspension
While a fixed loop[1|2] can work too, a noose would generally appear to be safer. There is absolutely no need to learn any hard complex knots. The more complex the knot is, the more friction it'll make and the harder it'll be to compress the neck. There are three possible ways to close the loop:
1- The slip knot is a frequently suggested knot, because it slides easily, can be quickly undone, and doesn't pinch.
2- Friction of slide can be reduced by using a carabiner[1|2], a metal ring[1|2], or a D-ring tied to the end of the rope.
3- Using asymmetric position of the noose (e.g., sitting on the floor[1|2], lying on the floor[1|2], or standing on a ladder[1|2]). A comfortable setups is lying on the bed[1|2|3] and using the bedframe as the anchor point for asymmetric noose, similar to hanging in lying-down position on a slope[1|2].
Knotting Tutorials
| Knot type | Step-By-Step Tutorial |
|---|---|
| Snuggle hitch (anchor point) | Knots you need: Snuggle hitch[1|2|3|4|5] |
| Slip knot (partial suspension) | How to Tie a Slip Knot How to DIY Knots Knots[1|2|3|4|5] Knot Tying: The Slip Noose[1|2|3|4|5] |
| Hangman's knot (long-drop suspension) | How to Tie a Hangman's Noose Knot[1|2|3|4|5] |
Level of the neck
The sweet spot to stick the rope on the neck is on carotid bifurcation (the division of the common carotid artery into internal and external carotid arteries), where carotid sinus massage[1|2|3|4] is performed. In order to reach the ideal spot, place the rope 1―2 fingers widths under the middle of the Adam's apple and push forward with a slight downward angle. In other words, as demonstrates how choking game[1|2|3|4|5|6|7] is done, instead of weighing down, lean forward and keep your head upright to prevent the pressure on your trachea. Girl's ligature from the choking game video looks similar to restraint collars[1|2|3|4|5], S&M chokers, or padded black neck brace. Since it's so thick and padded, it's some kind of a neck brace or ankle strap[1|2|3] used after an injury. Or you can breath in and out 10 times laying down on floor and quick get up; hold your breath, and do like in the choking game video[1|2|3|4|5|6] and you pass out.1- The best placement: As forum members have suggested, placing the rope approximately in the middle of the neck while tilting the head downwards made them passing out within seconds. The best placement of the rope is halfway between your Adam's apple and the base of your neck. Or about one to two fingers widths down from the middle of the Adam's apple. If you visually sectioned the neck into thirds, it would be the first line up from the bottom. This is the most comfortable spot. The perfect position to put the rope on are shown by ligature marks from front[1|2] and side[1|2] photos. It's easy to compress everything and pass out in about 10 seconds with no airway restriction or discomfort. By going lower from the the Adam's apple, you can use the sternocleidomastoid[1|2|3] to compress the common carotid arteries[1|2|3] by pressing it into the omohyoid[1|2|3] with the rope, while still protecting the trachea from the rope with the same muscles. The omohyoid travels deep towards the sternocleidomastoid[1|2|3], which confines the omohyoid muscle[1|2|3] in order to give it its distinctive angle, along with the deep cervical fascia. In short, carotid arteries and jugular are much easier to close off at the bottom of the neck than the top, especially in the standing or kneeling position (as shown in the diagram[1|2|3]), if you lean into it perfectly. Here[1|2] is an example of a girl who leaned backward while her head tilted forward; she could have faced the opposite direction.
2- The mediocre placement: The author of "Choosing a dignified ending" recommends placing the noose at the base of the neck, causing mild build up of pressure while avoiding irritation of the throat, which is protected by muscles at that area. It's okay to put the rope at the very base of the neck with the rope resting on the collar bones before tightening, but it's still not the recommended spot. The muscles at the base of the neck are big enough to protect the trachea, but they're too big to allow you to easily compress the arteries going to the brain.
3- The most uncomfortable placement: Placing the noose high up the neck[1|2|3] will constricts the trachea. Constricting the trachea will causes a urge to cough or a feeling of choking. Forum members have reported that putting the pressure high on the neckline above the trachea was causing them to cough and they couldn't breathe properly—because anytime they went to swallow, their trachea had to raise, but it was not possible due to trachea being blocker by the cord. Near the jaw, the carotid arteries branch on both sides. Of course, you can compress them up there, but it requires more force because one branch is deeper. This placement of the rope has a higher rate of failure due to the fact there are now 4 paths instead of 2. Not to mention it crushes your trachea.
Finding carotid artery
Place your hands behind your neck[1|2|3] as you would do when stretching. Place your thumbs left and right below your jaw and move them backwards until you reach the gap between your jawbone and throat left and right of your windpipe. You should clearly feel your pulse when applying light pressure. Now you can interlink the tips of your other fingers behind your neck—just below or partially on the end of your skull. All you need to do now is to press backwards and upwards with our thumbs (towards or below the end of your skull) with moderate force. You will go limp within 5 to 15 seconds. If you do not or feel pressure building inside your head, you are either not pressing hard enough or your thumbs are misaligned. You won't pass out but your body will go almost completely limp for few seconds, best do it while sitting or lying down.
You shouldn't do it more than one or two times a day; otherwise, you will get a headache.
Body positions
(Khokhlov, 2001) calculated the weight of suspension, in different positions[1|2], with the following results:
Kneeling[1|2] is often discouraged in favor of sitting[1|2] or standing[1|2] with legs straight, because the former is thought to make cancellation more difficult.
Required time
(Sauvageau et al., 2011) analyzed 14 filmed hangings in which rapid loss of consciousness had occurred in 10 ± 3 seconds and mild generalized convulsions in 14 ± 3 seconds. The type of suspension (partial or full), position of the partial suspension, and ethanol intoxication did not influence the timing of the agonal responses. The start of the deep abdominal respiratory abdominal movement occurred significantly faster in autoerotic practitioners (who often play for a longer period with the hanging process before the final hanging), whereas the loss of muscle tone was significantly delayed. Moreover, (Sauvageau, Ambrosi and Kelly, 2012) studied 3 nonlethal ligature strangulations, presented by an autoerotic practitioner. The loss of consciousness occurred in 11 seconds, similar to the time observed in hanging (10 ± 3 seconds). The loss of consciousness was closely followed by the onset of convulsions (7 – 11 seconds), in comparision to 14 ± 3 seconds in hanging. Later phases in hanging are decerebrate rigidity at 19 ± 5 seconds, start of the very deep respiratory attempt at 19 ± 5 seconds, decorticate rigidity at 38 ± 15 seconds, loss of muscle tone at 1 minute 17 seconds ± 25 seconds, end of the very deep respiratory attempt at 1 minute 51 seconds ± 30 seconds, and last muscle movement at 4 minutes 12 seconds ± 2 minutes 29 seconds.
(Sauvageau, LaHarpe and Geberth, 2010) analyzed agonal sequences eight filmed hangings. Rapid loss of consciousness was observed (at 8 – 18 sec), closely followed by convul-ions (at 10 – 19 sec). As for the respiratory responses, all cases presented deep rhythmic abdominal respiratory movements (last one between 1 min 2 sec and 2 min 5 sec).
Historically speaking, the body of executed persons in India of an executed person were kept hanging for less than half an hour (Bansal, 2005). Rare cases of survived hanging after a suspension duration of 5 – 10 minutes and up to 15 minutes (Hausmann & Betz, 1997). Except in vagal stimulation, death is not immediate in cases of hanging. It is unlikely to occur before the end of 5 minutes and may take as long as 20 minutes thus explaining how death can occur tardily in victims of mechanical asphyxia. If there is no injury to the spinal cord and the stoppage of air is not complete, 5 to 8 minutes is the typical fatal period, but it is possible that life may be restored in extremely rare cases after even 30 minutes of suspension (Kodikara, 2006).
Consequences of failure
Although survival without neurological damage is possible, a failed hanging suicide attempt may result in serious permanent disability.Even if be saved during the attempt, death still may occur. Such cases of delayed success have been reported by Assistant coroner Anna Morris[1|2], Assistant coroner P. Harrowing[1|2], and Senior coroner Alison Mutch[1|2]. Survival in hanging depends upon many factors but it was mainly duration of suspension, early resuscitive measures and force applied for compression of neck. Time required for irreversible cerebral damage to occur is said to be variable, but consensus of opinion is that if the blood supply to brain has been cut off continuously for less than 4-5 min permanent brain damage is very unlikely (Sane, 2015).
(Amalnath, Jawaid & Subrahmanyam, 2017) and (Ribaute et al., 2019) performed statistical analysis on neurological outcomes in suicidal hanging. (Kautilya, 2011) studied the frequency of neck injuries to inner tissues with regard to the type of hanging, hanging material, position of the knot and weight of the body, in order to to indicate the mechanism of injury to the organs. (Mikellides, 2018) discussed patterns of injury. Injury mainly arises through pressure on the neck veins and arteries. The external compression causes venous cerebral congestion, hypoxic circulation, and reduced arterial cerebral supply. Pulmonary complications include pulmonary edema (ARDS) and bronchopneumonia secondary to aspiration. Thyroid cartilage fractures are the most common with fractures of the hyroid bone and cricoid cartilage seen less often. Other neurological injuries include various spinal cord syndromes, focal cerebral deficits, transient hemiparesis, and larger infractions.
