Penetrating trauma may be associated with extracervical injuries and involve multiple organ systems within the neck Pattern of injury may not be limited to the pathway of the penetrating object Injury to blood vessels can be dramatic or subtle with an initially normal examination Vigilance and high index of suspicion are warranted History of large blood loss, pulsatile lesion, rapidly expanding hematoma, hypovolemic shock, or neurologic deficits (paresis, visual loss or aphasia, altered level of consciousness) indicates possible vascular injury Respiratory distress, stridor, hoarse voice, and speech difficulties may also be indicators of injury Spinal cord and vertebral levels are not the same In the cervical area, the cord level lies one segment higher than the corresponding vertebral level (C4 cord level lies opposite the C3 vertebral body) In the lower cervical area, a disparity of up to two levels may be present This means that physical injury and objective findings may not be straightforward Evaluate the chest for signs of major vessel injury, including hemothorax, widened mediastinum, and cardiac tamponade Current Evidence Penetrating neck trauma is uncommon in children, occurring in 0.28% of pediatric trauma patients, and most often is the result of a wound from a gunshot (usually low muzzle velocity