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

inside the body. An MRI creates detailed images of organs and tissues. An MRA focuses more on the blood vessels than the tissue surrounding it. Usually, the MRA is done in conjunction with the MRI. MRAs evolved from MRIs to give doctors the ability to look at blood vessels more thoroughly.

      —Plain radiographs: Images that identify bone and laryngotracheal injuries. Plain radiographs are not recommended for emergent evaluation of the vasculature in nonfatal strangulation (Appendix 7).

       REFERENCES

      1.Faugno DF, Speck PM, Spencer MJ, Giardino AP, eds. Sexual Assault Quick Reference: For Health Care, Social Service, and Law Enforcement Professionals. 2nd ed. Saint Louis, MO: STM Learning, Inc; 2016.

      2.Ditton M, Gray L. The ABC’s - Anatomy, “Bunk” and the Courtroom of Sexual Assault. Fort Wayne, IN: Socratic Parenting, LLC; 2015.

      3.Pollitt EN, Anderson JC, Scafide KN, Holbrook D, D’Silva G, Sheridan DJ. Alternate light source findings of common topical products. J Forensic Nurs. 2016;11(3)97-103.

      4.Herman Kabat. Acute arrest of cerebral circulation in man. Arch Neurol. 1943;50(5):510-528.

      5.Matusz EC, Schaffer JT, Bachmeier BA, et al. Evaluation of nonfatal strangulation in alert adults. Ann Emerg Med. 2019;S0196-0644(19)30594-3.

      6.Sauvageau A, Boghossian E. Classification of asphyxia: the need for standardization. J Forensic Sci. 2010;55(5):1259-1267.

      7.Stark P. Principles of computed tomography of the chest. UpToDate Web site. http://www.uptodate.com/contents/principles-of-computed-tomography-of-the-chest?source=preview&search=CAT+Scan&language=en-US&anchor=H1&selectedTitle=1~150#H1. Updated April 22, 2019. Accessed December 4, 2019.

      8.Raby BA. Basic principles of genetic disease. UpToDate Web site. http://www.uptodate.com/contents/basic-principles-of-genetic-disease?-source=machineLearning&search=DNA&selectedTitle=1~150&section-Rank=1&anchor=H5203404#H5203404. Updated May 31, 2019. Accessed December 4, 2019.

      9.Training Institute on Strangulation Prevention, California District Attorneys Association. The Investigation and Prosecution of Strangulation Cases. San Diego, CA: California District Attorneys Association, California Emergency Management Agency; 2013.

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      12.Spasmodic dysphonia. National Institute on Deafness and Other Communication Disorders Web site. https://www.nidcd.nih.gov/health/spasmodic-dysphonia. Updated March 6, 2017. Accessed May 28, 2020.

      13.Bass JB Jr. Dyspnea. In: Walker HK, Hall WD, Hurst JW, eds. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Boston, MA: Butterworths; 1990. National Center for Biotechnology Web site. https://www.ncbi.nlm.nih.gov/books/NBK357/. Accessed December 4, 2019.

      14.What’s an ENT? American Academy of Otolaryngology - Head and Neck Surgery Web site. https://www.enthealth.org/whats-an-ent/. Accessed December 4, 2019.

      15.US Department of Justice, Office on Violence Against Women. A National Protocol for Sexual Assault Medical Forensic Examinations: Adults/Adolescents. 2nd ed. Washington, DC: US Department of Justice, Office on Violence Against Women; 2013. National Criminal Justice Reference Service Web site. https://www.ncjrs.gov/pdffiles1/ovw/241903.pdf. Accessed December 4, 2019.

      16.MRI. Mayo Clinic Web site. http://www.mayoclinic.org/tests-procedures/mri/home/ovc-20235698. Accessed December 4, 2019.

      17.Parkes J, Thake D, Price M. Effect of seated restraint and body size on lung function. Med Sci Law. 2011;51(3):177-181.

      18.Pulse oximetry. Johns Hopkins Medicine Web site. http://www.hopkinsmedicine.org/healthlibrary/test_procedures/pulmonary/oximetry_92,p07754/. Accessed December 4, 2019.

      19.National Sexual Violence Resource Center. Sexual Assault Response Team Development: A Guide for Victim Service Providers. Enola, PA: National Sexual Violence Resource Center; 2011.

      20.Introduction to the SANE Program Development and Operation Guide. Office for Victims of Crime Training and Technical Assistance Center Web site. https://www.ovcttac.gov/saneguide/introduction/. Accessed December 4, 2019.

      21.Ungar A, Rivasi G, Rafanelli M, et al. Safety and tolerability of Tilt Testing and Carotid Sinus Massage in the octogenarians. Age Ageing. 2016;45(2):242-248.

      22.Doberentz E, Schyma C, Madea B. Histological examination of the carotid bifurcation in case of violence against the neck. Forensic Sci Int. 2012;216(1-3):135-140.

      23.Sauvageau A, Laharpe R, King D, et al. Agonal sequences in 14 filmed hangings with comments on the role of the type of suspension, ischemic habituation, and ethanol intoxication on the timing of agonal responses. Am J Forensic Med Pathol. 2011;32(2):104-107.

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      27.Fineron PW, Turnbull JA, Busuttil A. Fracture of the hyoid bone in survivors of attempted manual strangulation. J Clin Forensic Med. 1995;2(4):195-197.

      28.Iacovou E, Nayar M, Fleming J, Lew-Gor S. A pain in the neck: a rare case of isolated hyoid bone trauma. J Surg Case Rep. 2011;2011(7):3.

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*Data from Glass N, Laughon K, Campbell J, et al. Non-fatal strangulation is an important risk factor for homicide in women. J Emerg Med. 2008;35(3):329-335.

      Section II

       CASE STUDIES

       OBJECTIVES

      After completing the exercises presented in this chapter, the student will be able to:

      1.Correctly identify the anatomy of strangulation patients.

      2.Identify and document injuries based on an analysis of case photographs.

      3.List at least 3 items of evidence that should be collected.

      4.Discuss treatment and discharge instructions.