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Learning More about Strangulation

What is strangulation?

Many victims of interpersonal violence experience attempted strangulation (or “choking”). 

Strangulation is a type of asphyxiation characterized by a closure of blood vessels and/or air passages of the neck as a result of external pressure.  Ligature strangulation includes the use of any type of cord-like object, such as an electrical cord or purse strap. Manual strangulation may be done with hands, forearms (i.e. the “sleeper hold”), or even kneeling or standing on the victim’s neck or throat. Closing off the airways prevents a person from breathing.  Any one, or a combination, of these events can result in unconsciousness. Notably:

  • Only eleven pounds or more of pressure applied to both a person’s carotid arteries for merely ten seconds can cause unconsciousnes.
  • To completely close off the trachea, approximately 33 pounds of pressure is required.
  • If strangulation persists, brain death will occur in 4-5 minutes.

You may believe you were being killed and, as a result, feel deeply and justifiably terrified both during the incident and for a long time afterwards. 

Call 911 immediately, if you were strangled, and get a ride to the nearest emergency room. If you call 911 to report strangulation, tell the dispatcher you need paramedics, in addition to law enforcement. 

What are the health consequences of strangulation?

Strangulation is one of the deadliest forms of abuse. Unconsciousness may occur within seconds and death within minutes. Although you may feel normal shortly after the incident, attempted strangulation can cause very serious medical problems.  Some of the side effects of strangulation might not show up for hours or even days after the attack.

Signs of Strangulation:

  • Face: red or flushed, pinpoint red spots (petichiae), scratch marks
  • Eyes and eyelids: petichiae to the left or right eyeball, blood shot eyes
  • Nose: bloody nose, broken nose, petichiae
  • Finger tips: bruises are circular and oval and often faint
  • Ear: petichiae (external and/or ear canal), bleeding from ear canal
  • Mouth:  bruising, swollen tongue, swollen lips, cuts/ abrasions
  • Under the chin: redness, scratch marks, bruise(s), abrasions
  • Chest: redness, scratch marks, bruise(s), abrasions
  • Shoulders: redness, scratch marks, bruise(s), abrasions
  • Neck: redness, scratch marks, finger nail impressions, bruise(s), swelling, ligature mark
  • Head: petichiae (on the scalp)
  • Ancillary findings: hair pulled, bump(s), skull fracture, concussion

Symptoms of Strangulation:

  • Voice changes: raspy voice, hoarse voice, coughing, unable to speak, complete loss of voice
  • Swallowing changes: trouble swallowing, painful to swallow, neck pain, nausea/vomiting, drooling
  • Breathing changes: difficulty breathing, hyperventilation, unable to breathe
  • Behavioral changes: restlessness or combativeness, problems concentrating, amnesia, agitation, post-traumatic stress syndrome, hallucinations
  • Involuntary urination or defecation
  • Coughing / vomiting
  • Loss of consciousness/ fainting
  • Dizziness/ headaches

Note: You may have experienced serious injuries, even if you do not have any visible signs.

If you are pregnant, attempted strangulation can have an impact on the baby (fetus). You should be evaluated by your doctor, immediately.

Paying attention to, and documenting, changes in your signs and symptoms can be critical to determine the nature and scope of your injuries. Find out more, here.