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Introduction: Emergency Tracheotomy is a life saving procedure for patients with "Can't ventilate, can't intubate" situation. The commonest indication of tracheotomy has changed from inflammatory causes in the past to the present day prolonged intubation.Objective: To review the indications and early complications of emergency tracheotomy.Methods: A retrospective study of patients who underwent emergency tracheotomy from 2005 to 2010. The study was conducted at R.L.Jalappa hospital and research centre attached to Sri Devaraj Urs Medical College, Kolar. Data was obtained from Inpatient records and operative notes. Results: Our study includes 105 patients 31 female and 74 males, age ranging from 1 yr to 80yrs.with mean age of 41 yrs. The majority of patients were in third decade (Fig 1). The commonest symptom of presentation was stridor, followed by severe oro-nasal bleeding secondary to faciomaxillary trauma and cut throat injuries. Most common indication was tumours of neck region followed by deep neck space infections. Complications include haemorrhage and surgical emphysema which were handled efficiently there were no deaths due to the procedure.Conclusion: Open surgical tracheotomy is a safe and reliable method of restoring airway. There should not be any hesitation to do tracheotomy as its safety is well established. The need for the tracheotomy should be decided by what the situation demands.