Near-hanging and strangulation injuries can result in multiorgan failure. A 13-year-old male sustained an ischemic anoxic cerebral injury that was followed by an encephalopathy lasting approximately 30 hours and pulmonary edema lasting more than 48 hours. The patient was treated with continuous positive pressure ventilation followed by spontaneous breathing with continuous positive airway pressure by a mask; shock was reversed. The loss of cardiovascular competency and pulmonary insufficiency are problems frequently encountered in the patient who has sustained an hypoxic insult. Cerebral injury can result from hypoxemia related to tracheal compression, aspiration, and pulmonary edema; cerebral vascular engorgement secondary to venous compression; and ischemic anoxia related to arterial compression. Cerebral changes continue after circulatory and pulmonary competence has been restored. Multiorgan monitoring and control including intracranial pressure monitoring may be required to guide therapy. Respiratory distress syndrome may develop secondary to multiple factors including autonomic reflexes triggered by cerebral hypoxia and edema.