The Sentinel Bleed for a T I Fistula?

The classic massive presentation of this will be catastrophic bleeding in and around the airway. You are literally pumping arterial blood directly in to the trachia. So you got a few minutes until this patient sanguinates directly into their lungs. The person you're going to call is somebody who can emergently perform a sternotomy and then address a vascular emergency. Who that may be might depend on your setting.