SH: Works in an office as a manager. No drug or alcohol abuse.

ROS: She does complain of pain at the side of her neck where she has an abrasion from the attempted strangulation. She has no problems swallowing, no voice changes, and no cervical pain. She has no laryngeal pain. She denies any head trauma with the assault. She has no shortness of breath or abdominal pain. She does have some chest wall pain on the right posterior chest area where she was kicked. The pain increases with deep breathing. Her wrists and ankles are sore from the duct tape getting ripped off. She also has some pain on both cheeks where she has an abrasion from the duct tape being ripped off.

PE: BP=110/80, RR=16, HR=80, Temp= afeb, Sat=96 on room air.

This female, obviously distressed (clearly had been crying), but is alert, cooperative, and appropriate. She is with her sister who is comforting her.

HEENT: PERRL, EOMI, neck supple, no cervical spine pain. Oropharynx normal. Mild abrasions on both cheeks in the pattern of duct tape. Neck with bruising (shape of a hand) with bruises on both areas of carotids. She has no tenderness to the larynx. Her voice is normal (per patient and sister).

Heart: RRR, no murmurs. Lungs: =BX, no rales.

Chest wall: Small contusions posteriorly (T8-9 area, just below scapula) to right lower rib cage. Some point tenderness over these ribs is noted. No thoracic or lumbar spine tenderness. Abd: Soft, nontender even to deep palpation in RUQ and LUQ. Normal BS. No contusions or abrasions noted. Ext: Duct tape abrasions noted to both ankle areas; otherwise normal.

Neuro: Alert, oriented x3. Nonfocal exam.

1. Should you do rib films to look for rib fractures?
2. What should you do if you were worried about a laryngeal injury from the strangulation attempt?
3. If a patient has a laryngeal injury and needs intubation, what should you do?
4. If her workup is negative, and you discharge this patient, and she returns DOA to the ED, what is the most likely cause of their death?

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