EMERGENCY CASEBOOKS Two cases of near asphyxiation in children, using non-releasing plastic garden ties

Case 1 A 6 year old boy presented after his older brother had put a non-releasing garden tie around his neck during unsupervised play in the garden. He was unable to release the tie and in his attempt to do so, pulled it tighter. Fortunately, his grandmother was quick to respond and cut the tie oV with kitchen scissors. On examination, he had petechiae over his face but neither neck swelling or apparent trauma to his larynx. He had a 1 cm × 1 cm, V shaped laceration to his neck where the tie had been cut oV. He required no treatment other than a warning of the obvious dangers of his actions. Case 2 A 10 year old boy arrived as a helicopter transfer to the Birmingham Children’s Hospital Accident and Emergency Department after near asphyxiation secondary to a similar but larger non-releasing tie around the neck. This incident occurred on a golf course and his father’s attempts to remove it only served to tighten it further. No one had a sharp implement to hand and the ligature was in place for 5–10 minutes before finally being removed. When the paramedic team arrived, the child was unresponsive but self ventilating. On assessment in the A&E department he had facial congestion with central cyanosis with extensive well demarcated petechial haemorrhages from the neck upward and bilateral conjunctival haemorrhages (fig 1). He was extremely agitated and confused, being totally uncooperative. He was stabalised, intubated and ventilated. Subsequently he underwent computed tomography, which showed mild cerebral oedema. He was transferred to the paediatric intensive care unit for monitoring and was extubated that evening with no apparent neurological deficit. He was observed for a further 48 hours and was fortunate to survive this episode without sustaining major neurological injury.