Domestic Violence and Nonfatal Strangulation Assessment. Patricia M. Speck, DNSc, ARNP, APN, FNP-BC, DF-IAFN, FAAFS, DF-AFN, FAAN

      Section I

       DEFINITIONS AND ANATOMIC REVIEW

       OBJECTIVES

      After reviewing the information presented in this section, the participant will be able to:

       1.Identify anatomic structures of the neck

       2.Define strangulation and the language associated with strangulation

       3.Describe the possible signs and symptoms experienced during and after strangulation

       4.Recognize the different presentations of complications occurring after strangulation

       5.Critically analyze recommended treatment pathways for the patient who experiences strangulation

       INSTRUCTIONS

      An anatomic diagram of the neck helps the participant correctly identify anatomic landmarks. Participants, refer to the anatomic diagram using definitions that follow for documentation of normal anatomy, identifying and describing injury, and noting other conditions or findings throughout Domestic Violence and Nonfatal Strangulation Assessment.

      Additionally, the authors encourage participants to review the sections on presenting and developing symptoms, the potential for lethality, and recommended assessments and treatment as a supplement to the exercises in Domestic Violence and Nonfatal Strangulation Assessment. With the structured learning presented in this publication, students will familiarize themselves with signs and symptoms of strangulation and current treatment recommendations available to better identify and respond to cases of strangulation and properly document visible physical injuries.

       STRANGULATION LANGUAGE AND DEFINITIONS

      —Abrasion (scratches and scrapes): Superficial injuries to the skin that are limited to the epidermis and superficial dermis. Abrasions are normally caused by rubbing, sliding, or compressive forces against the skin.¹ A variety of traumatic abrasions may result from strangulation:

      —Chin abrasion: Incurred when, in an effort to protect the neck, the victim instinctively lowers the head and creates a compression sliding of the chin against whatever is applying external pressure to the neck.

      —Impression mark abrasion: Occurs when fingernails abrade the skin leaving a curvilinear (ie, semicircular) mark(s).

      —Ligature mark abrasions: Typically horizontal abrasions left on the neck that follow a predictable pattern. Distinguishable from suicidal hanging marks because the suicidal suspension ligature mark rises diagonally toward the ear. However, if pressure is applied with a ligature at an upward angle, the mark may be indistinguishable from suicidal hanging marks.

      —Scratch mark abrasion: Long, superficial abrasions that may be as wide or narrow as the fingernail itself. Scratch marks may be caused by the assailant or may be a defensive wound caused by the victim trying to remove the hand(s) or object applying pressure to their neck.

      —Alternative light source (ALS light): A valuable tool that helps detect the presence of potential forensic evidence (eg, urine, sweat, semen, saliva, vaginal secretions, fibers) and other substances (eg, lotion, oils, powders) that would otherwise remain invisible to the naked eye. The area fluoresces, or glows, allowing samples to be collected; however, the collector cannot confirm the origin of the substance or fiber at the time of collection.^2,3

      —Anoxia: The absence of oxygen. During strangulation the brain suffers an anoxic injury when the blood supply is completely obstructed.

      —Anoxic seizure: Tonic-clonic seizure activity lasting 2 to 8 seconds; results from an anoxic insult to the brain.⁴

      —Asphyxia: A general term which indicating the body is deprived of oxygen. Causes of asphyxia are divided into 4 primary categories: suffocation, strangulation, mechanical asphyxia, and drowning.^5,6

      —Bruise or contusion: An area of hemorrhage of soft tissue caused by the rupture of blood vessels from blunt trauma. Contusions may be present in skin and internal organs. Some contusions express a pattern. A patterned injury is one which has a distinct pattern that may reproduce the characteristic of the object that caused the injury. The pattern may be caused by the impact of a weapon or other object on the body or by contact of the body with a pattered surface. Deep bruising is typically not visible externally. However, in physical injury, pain over an area without visible hemorrhage is presumed to be bruised/contused. Estimation of the age of contusions based on its color is imprecise and not supported by forensic science evidence.⁵ However, there is staging of bruising and injury associated with healing stages—hemostasis, inflammation, proliferation, maturation—where bruise staging is possible during microscopic evaluation at autopsy.

      —Chin