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House Rule - Strangulation
When a character is strangled by an instrument (such as a noose) or an attacker, use the rules below:
A character can strangle or choke a character of the same size category or one size larger or smaller. (For example, a Medium-size creature can strangle a Small, Medium-size, or Large target.) The strangling attempt incurs an attack of opportunity.
To begin the choke, the attacked must succeed at a grapple attempt. If the grapple succeeds, the attacker can choose to deal normal unarmed damage as well as choke the target. The target can hold his breath for a number of rounds equal to his Constitution score. During this period of time, the target must make a Fortitude save (DC 12 + 2 for each previous check) every round to continue holding his breath. The target falls unconscious on either a failed check or if they run out of rounds. At that point, if the attacker continues the hold, the target will take damage as per drowning rules until dead or released.
If at any time the target breaks free or slips free of the grapple, the stranglehold is broken (though any damage that was dealt remains.) Note that a grappled target who is not pinned can use his attack action to strangle his attacker.