Background: Aspiration of foreign body, especially pill aspiration, can occur to both outpatients and inpatients. Endotracheal tube block induced by an inhaled foreign body can be a life-threatening complication during resuscitation. Case report: A 77 year-old female patient developed choking and coughing after taking herbal pills. Diagnosis of pill aspiration was suspected. Artificial coughing techniques were performed but were unsuccessful. Her respiratory failure became worse, and she was intubated and ventilated with a manual bag-valve resuscitator ("ambubag"). The aspirated pill was expelled through the endotracheal tube and the patient was extubated successfully. Why should an emergency physician be aware of this? : The endotracheal tube in patients with foreign body aspiration should be observed closely because the inhaled foreign body may enter the tube with a risk of airway obstruction.