A 78-year-old male presented to the emergency department after a fall. Initially, he was hemodynamically stable, however he subsequently became hypotensive and produced a large volume of bloody emesis. His past medical history was notable for atrial fibrillation for which he took warfarin. He had no previous surgeries and his family history was non-contributory. After correction of his warfarin-induced coagulopathy and transfusion of 5 units of packed red blood cells, he was admitted to the intensive care unit. He was orotracheally intubated for airway protection and an 8.5 Fr introducer was placed in the right neck using ultrasound guidance.