Rupture of the carotid arteries, which provide blood supply to the head and neck, results in massive haemorrhage leading to death within a matter of minutes in 33% of cases. Those who survive are frequently left handicapped. Patients with head and neck cancer who are over 50 years of age with excessive weight loss and reduced haemoglobin, have a greater risk of carotid artery damage leading to rupture, as have those with existing nutritional deficiencies, cardiovascular or renal disease, or endocrine disorders. Prevention includes improving the nutritional status, preventing infection and constipation, promoting healing and using safe suctioning. The signs of impending rupture are few and include: retro-sternal or high epigastric pain, pulsation of the wound, ballooning of the artery and, occasionally, a small 'herald' bleed. Nurses need to be aware of 'at risk' patients, and the warning signs. All ear, nose and throat wards should document an evidence-based protocol for the management of carotid artery rupture.