Management of Patients with Hanging History

Initial Assessment and Management

Ensure scene safety before approaching the patient, as recommended by the British Medical Journal, to prevent further harm 1, 2
Activate emergency medical services immediately, as advised by the American Heart Association, to facilitate prompt medical attention 3
Check responsiveness by tapping the victim and shouting, as suggested by the American Heart Association, to assess the patient's level of consciousness 3
If unresponsive, assess airway, breathing, and circulation, as recommended by the British Medical Journal and the American Heart Association, to identify potential life-threatening conditions 3, 4
If no breathing or abnormal breathing (gasping), begin CPR immediately, as advised by the American Heart Association, to restore blood circulation and oxygenation 3

Open the airway using head tilt-chin lift maneuver, as recommended by the British Medical Journal, to establish a patent airway 4, 5
Remove any visible obstruction from the mouth, as suggested by the British Medical Journal, to clear the airway 1, 2
Avoid maneuvers to relieve foreign body airway obstruction, as advised by the American Heart Association, as they are not indicated and may cause harm 6

Begin chest compressions if no pulse is detected within 10 seconds, as recommended by the American Heart Association, to restore blood circulation 3
Perform chest compressions at a rate of about 100 compressions per minute, depressing the sternum 4-5 cm, as suggested by the British Medical Journal, to optimize blood flow 5, 7
Continue CPR with a ratio of 30 compressions to 2 breaths until advanced care arrives, as advised by the American Heart Association, to maintain blood circulation and oxygenation 3

Consider supplemental oxygen for hypoxemic patients (oxygen saturation <94%), as recommended by the American Heart Association, to improve oxygenation 6

Assess for risk factors for suicidal behavior, including mood disorders, anxiety disorders, or substance abuse, as suggested by the American Academy of Child and Adolescent Psychiatry, to identify potential underlying conditions 8, 9

If the patient is breathing but unresponsive, place in recovery position to maintain airway patency, as recommended by the British Medical Journal, to prevent airway obstruction 4, 5
Monitor peripheral circulation if using recovery position, as suggested by the British Medical Journal, to prevent complications 5

The British Medical Journal recommends providing rescue breathing with 2 effective breaths (400-600 mL air per breath in adults) if the victim is not breathing but has a pulse present 10
The British Medical Journal suggests rechecking circulation every 10 breaths (approximately every minute) if the victim is not breathing but has a pulse present 11