Failed suicide attempt by hanging (near hanging): he survived
From the
Journal of Punjab Academy of Forensic Medicine & Toxicology (Online) Case Report
On the 1 st of Aug.’08 a married Hindu male of about 32 years was admitted in the Central Referral Hospital, Tadong, Gangtok with an alleged history of attempted suicide by hanging. He was a local taxi driver by profession and at the time of the incident, he was an inmate of the state prison under sec. 304(A) IPC for knocking down a peddler to death.
On that day he was found hanging from the ventilator of his cell by the jail authorities who rescued him within 4-5 minutes of the incident. He was unconscious and immediately rushed to Emergency Ward, CRH, Tadong, by the jail authorities.
At the time of admission he was unconscious and both pupils were fully dilated and not responding to light. Glasgow Coma Scale was computed to 5/15, (E1V2M2) with bilateral planter extensor. There were occasional generalized tonic-clonic seizures. SPO 2 at room air was 37% which was improved to 98% with 10L O 2 inhalation. However, on auscultation right side of the chest showed reduced air entry with few crepitations at the base. He was immediately intubated and put on mechanical ventilatory support in ICU and treated vigorously.
He was 5 feet and 7 inches in height and about 69.5 Kgs. in weight. There was no cyanosis and sub-conjunctival hemorrhage. Local examination revealed one oblique bluish purple color ligature mark around the neck measuring from 0.5 to 1.5 cm in width and 30 cm in length. It extended circumferentially around the neck forming a shallow abraded ligature mark. In the front it was placed just above the thyroid cartilage and on the right side of the neck it was placed 6 cm below the angle of the right mandible. On the left side of the neck the ligature mark was seen running 3 cm bellow and behind the left mastoid process and it disappeared on the back side of the neck. Anteriorly, the ligature mark was more or less horizontal but on both sides of the neck it ran obliquely upwards and backwards and it became very faint on the backside of the neck and untraceable just behind the left mastoid prominence, indicating the site of the knot. Ligature marks are shown in these images.
X-ray, CT Scan, funduscopy and other biochemical investigations were found to be within normal limits though there was some raise in total bilirubin level (2.7mg%). Respiration, pulse and blood pressure were all within normal range and there was no evidence of cyanosis and petechial hemorrhages.
There was very little hope of recovery as he went into deep coma. However, after about 29 hours of vigorous treatment, he regained consciousness slowly. Then he was extubated and treated conservatively with oxygen and other supportive measures. Later on he was discharged from the hospital with full clinical recovery. He was advised for further counseling in the psychiatric OPD of CRH, Tadong.
