Abstract
Tracheotomies are the most frequent surgical procedures performed in the intensive care unit. We present a case of major hemorrhage that occurred in the intensive care unit during an elective percutaneous dilational tracheostomy in a 46-year-old female diagnosed with multiple myeloma. The patient was later taken to the operation theatre and procedure-related cause of bleeding was ruled out. It was subsequently realized that the cause of bleeding was intrapulmonary and occurred coincidently with the tracheostomy.