Tracheotomy is a commonly performed surgical technique used for long-term mechanical ventilation, upper airway obstruction, need for pulmonary toilet, and as an adjunct to surgery where ventilation is anticipated. Urgent tracheotomy may be performed when difficulty is encountered during an elective tracheotomy, or when cricothyroidotomy is impossible or contraindicated due to distorted anatomy or laryngeal obstruction. Various methods of creating a tracheal opening have been described and each of these methods has technical advantages and disadvantages. In the urgent setting, a rapid and technically simple approach is needed for optimal results. We have used the Eisele tracheotomy punch (Pilling, Teleflex Medical, Research Triangle Park, NC) for all tracheotomies, both elective and urgent. In this report we describe five illustrative cases in which the tracheotomy punch was used successfully in the urgent setting to ensure rapid airway access.