Bleeding in the upper airway is a potentially catastrophic event and an important cause of airway-related mortality, even in otherwise healthy patients. The bleeding airway is particularly challenging because tools used by physicians to secure a difficult airway, such as direct video and flexible video/fiberoptic laryngoscopy, may be ineffective as the camera may become soiled with blood. A 33-year-old male with hemophilia A presented with a tongue laceration after a seizure. We present an upper airway emergency due to hemorrhage in hemophilia A, effectively managed with a strategy employing pre-intubation optimization, semi-recumbent position, and video laryngoscopy.