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Several days following anterior neck surgery, a middle-aged patient on therapeutic anticoagulation developed acute respiratory failure following extubation. Attempts at reintubation by the anaesthetic team were unsuccessful. The emergency physician (EP), responding as part of the hospital cardiac arrest team, found the patient cyanotic with rapidly deteriorating oxygen saturations. An emergency surgical airway was indicated, yet extensive anterior cervical oedema and postoperative distortion from the surgical approach had obliterated all recognisable surface landmarks.