Wednesday, February 6, 2013

Strangulation—How it Works

In my scene, I want to have the villain strangle the victim, using a picture wire. The death needs to be very fast. Will this work?
A wire tends to cut into the tissue of the neck, and isn't very broad--it'd be hard to place it directly over the hyoid, especially if the victim struggled.
Most victims will grab at the wire, twist their body, trying to dislodge it—this is survival instinct. The arms won't be flailing. If the victim is off the ground, they may kick.
I can't think of any protrusion or modification of the wire that would be so effective so fast that the victim won't struggle at least a bit. A protrusion that angles upward toward the base of the tongue, which would jam into the bone, might work. Still, death won't be instantaneous.
Let me give you an example.
I’ve seen a drunk driver—not wearing his seatbelt—who rear-ended a parked pick-up. The guy wasn’t going that fast, but his vehicle was old and didn’t have air bags. He hit his throat on the steering wheel. He had some pain in his neck, but drove home. By the time he got there, he was more and more short of breath. He woke his wife, and she drove him to the ER. On the way, he began clawing at his neck, wheezing with each breath.
By the time we got him, he’d had a cardiac arrest; we had to cut a hole in his throat for him to breathe.
X-rays showed his hyoid was broken. BUT, what killed him was swelling in the soft tissue of the neck that progressed after he hit his throat. This is part of the mechanism of strangulation. Here's an illustration of the neck and location of the hyoid bone—that should help with visualizing the process.
Cheers, Kelly

Thanks to Connie for this question!
Questions? Comments?

Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.

Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
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  1. Kelly, I have a question. My scenario is that the villain is removing women's larynxes as a non-medical professional in an attempt to silence them. What would the villain have to do in his botched up procedure that would leave the victim dead?


    1. Hello, Anne-Marie.
      A number of things would work.
      To an extent, it depends on whether you want the victim to die acutely or slowly.
      The fastest way is to damage the tissue around the larynx, cutting off the airway. The victim would suffocate to death within a few minutes. Damaging blood vessels in the neck--the carotid artery, or the jugular vein--could cause enough bleeding into the soft tissues of the neck to occlude the airway via swelling in the back of the throat.
      Infection (from not using sterile technique) could cause death, but not for several days. I've seen a patient with an abcessed tonsil develop pain and swelling in the neck due to spread of the infection (this is known as Ludwig's angina). Sent him to surgery withing the hour before he could occlude his airway.
      Hope this helps!
      Cheers, Kelly

    2. Thank you bunches!!! This is great!!

    3. Very welcome! Check back for all things medical!
      Cheers, Kelly

  2. HI Kelly! So when you seen a scene where someone is being choked either by an object around the neck or pushing up against the neck - that death isn't immediately from that particular movement. But rather it is the breaking of the hyoid and the swelling that results from it? SO unless the skin cuts through to the carotid arteries, this could be a much slower way to die.

    What about people who go unconscious from lack of air? Is it possible they could also suffer from this hyoid breaking and not wake up after passing out? I'm just curious as to how alive a person might be in order to over hear his would-be killer's plan :)

    Thanks ~ Killion

    1. Hello, Killion!
      The brain needs blood. A few seconds without blood flow causes unconsciousness. This is the so-called simple faint. You lay the victim down, more blood flows to the brain, and the victim wakes up.

      After a couple of minutes--like in a cardiac arrest situation--the brain is starving for oxygen, and the cells can be damaged. Waking up is harder, takes longer, and the victim may have deficits.

      Four to five minutes--and brain damage (enough to cause a vegetative state, as in organ donor) starts.

      All of this just from lack of blood flow through the carotid arteries.

      The initial stage of "strangling" is the result of the victim passing out from lack of blood flow. The they're defenseless.

      The perpetrator continues squeezing the neck.
      Breaking the hyoid usually collapses the airway. There is immediate soft tissue damage and swelling. Now you have impaired blood flow to the brain and impaired oxygen in the bloodstream.

      Lack of air alone won't break the hyoid. Strong hands--usually a man's hands--with thumbs over the hyoid is necessary to break it.

      Passing out from lack of air--like at altitude (a small plane is an example, or suffocating inside a plastic bag) is because of low oxygen. Defenseless victim.

      If the bad guy strangled the victim just enough to cause a faint (there would still be a pulse and breathing) the victim could potentially wake up and overhear the plans.

      Since the brain prefers glucose (sugar) as its food source, low blood sugar will cause passing out(example--a diabetic who takes their insulin then doesn't eat).

      Cheers, Kelly