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There may be absolutely no outward physical sign of the strangulation. Approximately 50% of documented cases exhibit no visible injury. An additional 35% have injuries that are too minor to photograph. (Training Institute on Strangulation Prevention, 2014) Therefore the absence of physical signs of strangulation does not exclude the event. This often means that the medical care is delivered and the legal case is built, solely on the subjective symptoms of the victim. When there are physical signs of strangulation, they are commonly non-specific and may be caused by a number of conditions or other trauma.

It is important to note that there are other causes for most, if not all, of these signs and symptoms.
Common subjective complaints: Common objective signs:
Neck/Throat Pain Redness/bruising/scratches to neck
Nausea Vomiting
Ears ringing ligature marks
Head Rush thumb print bruising/abrasion under chin
Spasm/seizure red eyes/subconjunctival hemorrhage (pictured)
Urination/Defecation cough/voice changes
Unconsciousness petechiae

*bolded items demonstrate evidence of asphyxia

Asphyxia is the most common serious bodily injury in a strangulation case. The immediate risk of injury to a strangulation victim is a progressive inflammation of the airway that causes a cessation of breathing hours after the event. For this reason, patients should be monitored or sent home with caregivers. The long term effects of non-fatal strangulation may be minor and limited only to coughing and a sore throat, or may be severe and result in permanent brain damage and/or stroke.

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