Strangled but Not Seen: Identifying Subtle Signs in the ED

Strangulation is a frequent occurrence in intimate partner violence (IPV) and sexual assault. It can be inflicted with a minor amount of force and result in serious injury. Importantly, its presence significantly increases the risk of death from IPV. It is surprising how many providers and patients alike underappreciate its significance. Many patients will not initially disclose strangulation and it is up to us to notice the signs and start asking questions.
This presentation will introduce the subtle clues during the exam that should prompt further investigation. It will provide tools for injury evaluation and description, and criteria to choose imaging and decide on the disposition. It will also provide some verbiage to use with the patient during counseling and discharge instructions. This information needs to be in the toolbox of every emergency physician.