Strangling

# Overview
Strangling is compression of the neck that leads to unconsciousness or death by causing an increasingly hypoxic state in the brain. Fatal strangling typically occurs in cases of violence, accidents, and as the mechanism of suicide in hangings. Strangling does not have to be fatal; limited or interrupted strangling is practiced in erotic asphyxia, in the choking game, and is an important technique and in many combat sports and self-defense systems (see Chokehold for further reading).
Strangling can be divided into three general types according to the mechanism used:
- Hanging  Suspension from a cord wound around the neck (see the separate article Hanging)
- Ligature strangulation  Strangulation without suspension using some form of cord-like object
- Manual strangulation  Strangulation using the fingers or other extremity

# General
Strangling involves one or several mechanisms that interfere with the normal flow of oxygen into the brain:
- Compression of the carotid arteries and jugular veins  causing cerebral ischemia.
- Compression of the laryngopharynx, larynx, or trachea  causing asphyxia.
- Stimulation of the carotid sinus reflex  causing brachycardia, hypotension, or both.
Depending on the particular method of strangling, one or several of these typically occur in combination, but vascular obstruction is usually the main mechanism. Complete obstruction of blood flow to the brain is associated with irreversible neurological damage and death, but during strangulation there is still unimpeded blood flow in the vertebral arteries. Estimations have been made that significant occlusion of the carotid arteries and jugular veins occurs with a pressure of around 3.4 N/cm2, while the trachea demands six times more at approximately 22 N/cm2. As in all cases of strangulation, the rapidity of death can be affected by the susceptibility to carotid sinus stimulation.  Carotid sinus reflex death is sometimes considered a mechanism of death in cases of strangulation, but it remains highly disputed. The reported time from application to unconsciousness varies from 7-14 seconds if effectively applied.  chokeholds to one minute in some other cases, with death occurring minutes after unconsciousness.

# Manual strangulation
Manual strangulation (also known as "throttling" in the UK) refers to strangling with the hands, fingers, or other extremities (sometimes also with blunt objects such as batons). In violence, this type of strangling is mostly done by men against women rather than against another man, because it generally requires a large disparity in physical strength between the assailant and the victim and also because men can be over twice as big as a woman in general. Depending on how the strangling is performed, it may compress the airway, interfere with the flow of blood in the neck, or work as a combination of the two. Consequently, manual strangulation may damage the larynx,, and fracture the hyoid or other bones in the neck. In cases of airway compression, manual strangling leads to the frightening sensation of air hunger and may induce violent struggling. More technical variants of manual strangulation are referred to as chokeholds, and are extensively practiced and used in various martial arts, combat sports, self-defense systems, and in military hand-to-hand combat application.
It is a mistake to refer to strangulation as "choke" or "choking". Choke means having the windpipe blocked entirely or partly by some foreign object like food.

# Ligature strangulation
Ligature strangulation refers to strangling with some form of cord or cloth such as rope, wire, or shoe laces, either partially or fully circumferencing the neck. Even though the mechanism of strangulation is similar, it is usually distinguished from hanging by the strangling force being something other than the person's own bodyweight. Incomplete occlusion of the carotid arteries is expected, and in cases of homicide, the victim may struggle for a period of time, with unconsciousness typically occurring in 10 to 15 seconds. Cases of ligature strangulation generally involve homicides of women, children, and the elderly, but accidents and suicides occur as well. Suicide by ligature strangulation requires that the constriction around the neck be held even after loss of consciousness, which can be accomplished with complicated knots.