Near-hanging injury results in multisystem insult and injury. Acute or delayed respiratory complications can result in death. A survivor can suffer neuropsychiatric sequelae ranging from amnesia to a prolonged vegetative state. Treatment is directed toward ensuring cerebral oxygenation, lowering increased intracranial pressure, and treating respiratory distress. Psychiatric consultation will be necessary in long-term survivors. Patients should be observed for at least 24 hours after a near-hanging injury.