Emergency clinicians are tasked with managing a variety of patients with acute deformities. One of the most acute situations management of the patient who presents with an airway emergency. Patients present with various pathologies may result in anatomically challenging intubation scenarios. Deferral of intubation is often not an option in the emergency department. In some cases, challenging anatomic issues can be predicted before beginning laryngoscopy, but in many situations, prediction models fall short. It is critically important for emergency clinicians to anticipate anatomic issues in all airways and to have premeditated strategies for managing them.