The Sword Swallower

Wow!

Being a resident, part of my training is performing procedures on little children. During these procedures we always practice on a stable child (one not about to possibly die) and we always have an expert on hand to guide us. Today I tried my hand at intubation of a little 30 week kid with gastroschesis (the baby's bowels are born outside it's belly).

Intubation first involves sedation of the child. After the child is sedated you then take a small blade with a light on the end and stick it down the child's throat. After that you use force to open the sedated child's airway up. At this point the baby's vocal cords, ect. should be in view. You then slide a small tube down the blade, through the cords, and into the trachea, which will be used to pass air down into the child's lungs....sounds simple right?

Why wouldn't it be simple? I've done this with many plastic dolls that are supposedly very "life-like" and they were all easy. Well, let me tell ya, its a bit different when it's a fragile looking little 32 week child with it's bowels hanging out in an "icing-sack". Another thing is that the word "sedated" is a term used very loosely with this child...it's been on pain medications for several days, so a tolerance to the medication has developed. So although he seemed sedate when I started to pry his throat open forcefully, he came right out of it....my attending told me this is perfectly normal (as the child is writhing, gagging, and fighting and I have a 3 inch piece of metal prying open his mouth) - "We used to do it without sedation...that was hard." (As if he is actually sedated right now.) I fight this little kid's head and arms which are ridiculously strong for such a little thing...but I guess having a 3 inch blade of metal forcibly jammed down your throat would give anybody a little bit of mad strength. Anyways long story short, I work on him for awhile never once gazing upon the vocal cords I'd heard so much about...I think it was after about 5-6 tries, each turn giving him a little break, then the respiratory therapist had a go...(while I wouldn't wish bad on anybody, it made me feel better that she couldn't get it either). But then my attending decides to give it a shot and WaaaLaaa! He shows me the vocal cords and in seconds has the tube slid down through them....How did he do that?!?!?! One SINGLE try!
As with anything in medicine, if you say to yourself "I can do that." or "That's easy enough." Get ready for a lesson...needless to say I obviously need more of them.