Appendix F: Clinical guideline: assessment and management of strangulation Figure 7: Clinical guideline: assessment and management of strangulation Strangulation (choking) management Management of strangulation depends upon the mechanism of injury, clinical picture of the patient and time since the strangulation event. The post-strangulation documentation (see Appendix L) form guides clinicians through the processes of care. Be aware that many victims of strangulation have minimal symptoms and signs following the event. If patient is alert, orientated, no loss of consciousness, no signs of compromised airways +/- superficial injuries to neck: ― ensure home support ― provide post-strangulation information sheet to patients ― consider referral to primary care for re-evaluation of signs and symptoms that may emerge within 48 hours of the event. History of loss of consciousness more than a few hours ago, but is currently clinically stable – ― assess and treat as for any other head injury ― ensure home support ― provide post-strangulation information sheet to patient ― consider referral to primary care for re-evaluation of signs and symptoms that may emerge within subsequent days. Significant neck pain, dysphagia or dysarthria – discuss/manage with emergency department support Reduced level of consciousness, confusion or compromised airway – usual emergency care provided and refer to the emergency department for urgent assessment/ management
Moderate risk If you do not think the person is in imminent risk or high risk, but there is evidence of violence within their relationship (eg, low-level recent or low-level ongoing violence), inform the person about the concerns that this raises, and connect them with options for help and support. Let them know that you are concerned about their safety, and that without help violence can increase in frequency and severity. Talk to them about what help and support they might get from family and friends and or from the community. 5 Referral and follow-up Referral to a specialist family violence agency, Police, lawyer, or (for under-17-year-olds) child protection services, such as Child, Youth and Family, if required. For all victims: letting them know that they are not responsible for and do not deserve the violence they have experienced, and assisting them to contact support services and access legal options for protection, may be the most powerful interventions you can offer. Appropriate follow-up at subsequent health care presentations also needs to be undertaken. 6 Documentation Thorough documentation of all steps of the health consultation is necessary. This includes recording the history, examination findings, results of the health and risk assessment, consultative process and the support agencies, referrals and follow-up plan agreed. Always include the date and time that you saw the person, and the date and time you wrote your notes (if different from the time you saw the patient). Always include a legible name, signature and practice designation. Remember to seek support from colleagues and/or debrief after the health care visit is concluded. Appendix O: Child abuse and neglect intervention flow chart * Tool for use in Emergency Departments for child up to the age of two years. # Standard interagency protocol, memorandum of understanding between DHB, CYF and Police and associated schedule 1. ^ Consult with experienced colleague and/or multidisciplinary team prior to a referral.