An ambulance was dispatched to a 40-year-old man with a stab wound. On arrival, the emergency physician found the patient lying face down with a large knife protruding from his back between the scapula and spinal column (Fig. 1). The vital signs were stable (blood pressure 120/70 mmHg, heart rate 90 min, respiratory rate 25-30 min, oxygen saturation 94%); the estimated blood loss was 500 ml. Oxygen was administered and two i.v. lines were inserted. After light sedation (diazepam), the patient was transported to the clinic in the face-down position. X-ray films and physical examination showed that the knife, with a length of about 30 cm, had penetrated 15 cm into the thorax; the tip was located at the diaphragm (Fig. 2). Endotracheal intubation for the surgical revision was performed with the patient in the face-down position: after topical anaesthesia of the nasal mucosa (cocaine), a fiberoptic device was introduced. Additional topical anaesthetic (lignocaine) was applied through the biopsy channel onto the mucosa of the larynx and pharynx. After a sufficient waiting period, the endotracheal tube was pushed over the fiberoptic device into the trachea without problems (Fig. 3). During the entire period the patient was awake and breathing spontaneously; no coughing or change of body position occurred. After correct placement of the tube, general anaesthesia was induced. During positioning of the patient in the operating theatre, the knife was unintentionally dislodged and critical bleeding occurred. The situation could be controlled by immediate transfusions and rapid surgical revision, which revealed injuries to the lung, diaphragm, and stomach. The patient recovered without severe complications.(ABSTRACT TRUNCATED AT 250 WORDS)