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Background: Kala Pathar poisoning has become an important cause of morbidity and mortality in our community. Because of lack of an effective antidote in this poisoning, treatment is presently focused mainly on relief of symptoms. Oedema of the upper airway is an important presentation of this condition. The aim of this study was to know whether tracheostomy can improve the situation in this fatal emergency. Material & Methods: Thirty-eight patients were studied over a period of about 2 years in a cross sectional study conducted in District Headquarter Teaching Hospital, Dera Ismail Khan. Relevant information, including symptoms signs and complications, were recorded and patients were divided into two groups depending upon whether they were subjected to tracheostomy or not. Results: Out of 38 patients 36(94.74%) were female and 2(5.26%) were male. Twenty-seven (71.1%) were unmarried and the same number i.e. 27(71.1%) of patients was from low socioeconomic class. Majority of the patients 23(60.5%) were from rural areas and in 36(94.74%) the poisoning was suicidal. Out of 38 patients 29 underwent tracheostomy and 10(34.48%) died despite this procedure. In the remaining 9 patients without tracheostomy 5(55.55%) patients died. Conclusion: Oedema of the throat and larynx is an important cause of morbidity and mortality in Kala Pathar poisoning and tracheostomy is having statistically significant role in improving the outcome.