As far as emergency bleeps go, a patient with impending airway obstruction is one of my least favourite. This lack of enjoyment is augmented when it is the middle of the night and you’ve just made a nice cup of coffee. However, you can be sure that at least there will always be something that is interesting and challenging when you arrive. There was one such recent case that provided just such a management challenge by virtue of its novelty (at least for us) that threw up several learning points for those of us involved and which I hope might make interesting reading. As always with these things, many of the facts have been adjusted (and stuff completely made up) for patient anonymity, but I think the learning points remain intact.