Immediate Medical Management of Asphyxia from Suicide Attempt

Initial Assessment and Resuscitation

• The American Heart Association recommends immediately assessing responsiveness and breathing, activating emergency services, opening the airway using head tilt-chin lift, providing rescue breathing if pulse is present but breathing is absent, and initiating high-quality CPR with chest compressions at 100-120/min if pulseless 1, 2
• The British Medical Journal suggests checking responsiveness by shaking the patient and shouting; if unresponsive, immediately activate emergency medical services 1
• The American Heart Association recommends opening the airway using head tilt-chin lift maneuver: place one hand on the forehead tilting the head back while lifting the chin with fingers of the other hand 3, 4
• The British Medical Journal recommends assessing breathing for no more than 10 seconds by looking for chest movements, listening at the mouth for breath sounds, and feeling for air with your cheek 3, 1
• The American Heart Association recommends providing rescue breathing at 10 breaths per minute (one breath every 6 seconds), with each breath taking approximately 2 seconds and achieving visible chest rise of 800-1200 ml tidal volume 3, 1
• The British Medical Journal recommends maintaining airway patency continuously with head tilt-chin lift throughout rescue breathing 3
• The British Medical Journal recommends reassessing pulse every 2 minutes while continuing ventilation 4
• The American Heart Association recommends beginning high-quality CPR immediately with chest compressions at 100-120 per minute, pushing hard (at least 5 cm depth) and allowing complete chest recoil 1
• The British Medical Journal recommends positioning hands correctly on the lower half of the sternum: locate where the ribs join the sternum, place middle finger at this point with index finger on sternum, then slide heel of other hand down to meet the index finger 4
• The American Heart Association recommends delivering compressions and breaths in a 30:2 ratio if alone, or 15:2 if two rescuers, minimizing interruptions in compressions 3, 1
• The American Heart Association recommends applying AED as soon as available and follow prompts for rhythm analysis and defibrillation 1
• The American Heart Association recommends administering epinephrine 1 mg IV/IO every 3-5 minutes once vascular access is established 1

Post-Resuscitation Stabilization

• The British Medical Journal recommends placing in recovery position (lateral recumbent with arm nearest you at right angle, far knee flexed) if breathing spontaneously but unconscious, to prevent aspiration and maintain airway patency 4, 5
• The American Heart Association recommends continuing monitoring for signs of airway occlusion, inadequate breathing, or deterioration in responsiveness 5
• The American Heart Association recommends repositioning supine immediately if any signs of life are uncertain or if respiratory status deteriorates 5
• The American Heart Association recommends avoiding excessive ventilation which can increase intrathoracic pressure and impair venous return 1

Mandatory Psychiatric and Safety Interventions

• The American Academy of Pediatrics recommends arranging immediate psychiatric evaluation during or immediately after medical stabilization to determine need for inpatient hospitalization 6, 2
• The American Academy of Pediatrics recommends assessing for high-risk indicators including persistent wish to die, continued suicidal intent, current agitation, serious depression, active substance use disorder, and inadequate support system 6, 2
• The American Academy of Pediatrics recommends admitting to psychiatric facility if any high-risk indicator is present, as this provides protected environment for complete evaluation and therapy initiation 6, 2
• The American Academy of Pediatrics recommends using involuntary commitment if patient or family refuses necessary hospitalization when immediate risk of self-harm exists 2
• The American Academy of Pediatrics recommends removing all firearms from the home immediately, as simply having a gun in the home doubles youth suicide risk and parents consistently underestimate children's ability to access locked firearms 2
• The American Academy of Pediatrics recommends locking up all medications including prescription and over-the-counter drugs 6
• The Annals of Internal Medicine recommends developing structured safety plan collaboratively with patient and family, including warning signs, coping strategies, social support contacts, and professional crisis resources 7, 2

Critical Pitfalls to Avoid

• The American Heart Association recommends not delaying CPR to assess for injuries or obtain history; resuscitation takes absolute priority 1
• The American Academy of Pediatrics recommends not relying on "no-suicide contracts" as these have not been proven effective in preventing suicidal behavior 6, 2
• The American Academy of Pediatrics recommends not discharging without confirmed psychiatric follow-up and means restriction verification 2
• The American Academy of Pediatrics recommends not assuming low risk based on method lethality alone; intent and psychiatric factors are more important than the actual danger of the method used 6
• The American Academy of Pediatrics recommends not underestimating access to locked firearms; adolescents frequently find ways to access supposedly secured weapons 2

Follow-Up Care Structure

• The American Academy of Pediatrics recommends maintaining contact with patient even after psychiatric referral to enhance continuity of care and treatment adherence 6, 2
• The American Academy of Pediatrics recommends scheduling closely-spaced follow-up appointments with flexibility for crisis visits 2
• The Annals of Internal Medicine recommends initiating evidence-based psychotherapy: cognitive-behavioral therapy (CBT) reduces post-treatment suicide attempt risk by half, while dialectical behavior therapy (DBT) is effective for patients with borderline personality disorder and reduces both suicidal and non-suicidal self-directed violence 7, 2