When the extended neck accelerates forward, striking a steering wheel or dashboard, the laryngeal structures are compressed posteriorly against the spine.Most injuries are due to blunt trauma rather than penetrating trauma.Usually seen in the setting of polytrauma and their presenting features often do not correlate with the extent of injury.In patients with head and neck trauma, it is the second most common cause of death after intracranial hemorrhage.Protection by the jaw, spine, and sternum.Rare, seen in about 1 in 30,000 ED visits.Options vary from observation to surgical repair to angiographic embolization or stenting.Treatment: depends on the vessel involved and accessibility of the lesion.Nine out of 10 patients with hard signs will have an injury requiring repair and should be rapidly transferred to the operating room or angiography suite.Assess the patient for “hard” and “soft” signs of injury.Instruct awake and cooperative patients to cough (to check for hemoptysis), to swallow saliva (to assess for dysphagia from esophageal injury), and to speak (to evaluate for laryngeal fracture).Any wound deep to the platysma raises concern for damage to the vital structures of the neck.Wounds that do not penetrate the platysma are largely not life threatening.The platysma is a thin muscle that stretches from the facial muscles to the thorax, demarcating superficial from deep wounds.The trajectory of the penetrating object can be difficult to determine clinically, and nearly half traverse multiple zones.Classically, zone II injuries undergo surgical exploration zone I and III wounds undergo further evaluation.Exsanguination is the proximate cause of death in most penetrating neck injury victims, apply direct pressure to wounds, but be careful not to simultaneously occlude both carotid arteries and or obstruct the airway.Listen for breath sides and signs of tension physiology Pneumothorax and hemothorax are present in up to 20% of patients with penetrating neck trauma.When bag-mask ventilation proves difficult due to airway distortion or physical characteristics, perform an awake, orotracheal intubation using a sedative without a paralytic.Assume a difficult airway in a patient with neck trauma.