Hanging is a common means of suicide worldwide. As per the Crime Records Bureau of India, hanging accounted for almost 53.6–57.8% of all suicidal deaths in 2019 and 2020, respectively. The incidence of hanging across emergency departments in India, as reported in previous studies, has varied from 5.3% and rising to 8.6% in recent times. The article aims to contribute to the understanding of the most optimal management of hanging patients in the emergency department. Hanging is defined as a form of asphyxia occurring due to the weight of the body being suspended by a ligature material around the neck. The common physical features of hanging noted in literature are facial congestion, petechiae, and cyanosis. These are considered classical signs of asphyxia. Patel et al. and Simonsen reported facial congestion in 77.5 and 52.5%, respectively. Clément et al. noted petechial hemorrhage in 46% of cases. The initial assessment of near-hanging patients begins with the advanced trauma life support (ATLS) primary survey. Airway, breathing, circulation, disability, and exposure are noted accordingly and intervened. Patients with Glasgow Coma Scale (GCS) <9 and signs of airway compromise (laryngeal fracture or tracheal trauma) require early intubation. It is worth noting that computed tomography (CT) of the neck and brain plays a crucial role in ruling out a majority of injuries associated with hanging, and it also assists in devising an effective management plan for these injuries. Over the years, the treatment and management of near-hanging have largely remained the same; however, the evaluation has changed with the advancement and easy availability of CT imaging at most centers. While the literature on the outcomes and management of hanging cases may be limited, prompt and appropriate treatment has shown to improve the chances of survival for most individuals.