Penetrating wounds to the neck occur in 5–10% of trauma cases and are associated with very high mortality due to proximity to and involvement of vital structures. Emergent airway management and rapid diagnosis in these injuries are essential for life-saving treatment. This case study presents the case of a stab wound to the neck in an adult patient which elicited major concern for cardiovascular, neurological, and airway compromise. In such a high-risk trauma airway, this case shows the importance of keeping a wide differential and the value of expeditious management to prevent anoxic brain injury and stroke. The rapid diagnosis of a left common carotid artery transection and subsequent surgical repair were essential in this patient’s full neurological recovery.TopicsTrauma, stab wound, neck hematoma, deviated trachea, carotid artery injury, carotid artery transection.