tracheostomy take two...

Now, I have actually done tracheostomies.
Usually for respiratory failure, you place an endotracheal tube...which makes me wonder why they didn't do that for the pope.
However, I have done several while in Africa.
One of the complications of post measles was a severe tracheobronchitis.
Usually these kids were malnourished to begin with, and often didn't survive...and if you did the tracheostomy and they lived, you would be blamed for the death. Again, usually we didn't do the procedure.
But I did two. One was a fat two year old, and he made it.
Another was a girl with epiglottitis..about 10 years old. We didn't have blood gas measurements, but it was obvious she was going into respiratory failure and arrest. So we got permission and took her to the operating theatre.
The head nurse/anesthetist put her into a light anesthesia, but couldn't get the tracheostomy tube down. I tried, and again we couldn't get past the large swollen epiglottis..
So with the patient crashing on us, I did an emergency crycothyroid incision, stuck in a pair of scissors, and the patient turned pink, thank the Lord. (one usually doesn't do it at this level because of the danger of stenosis down the line).
Tracheostomies are not easy, nor is intubation in emergency rooms...when in training, we lost a child on the table (not my case) from a problem quite similar to the one I describe above... and an adult from bleeding--the carotid arteries, the jugular vein, and the vascular thyroid is very close to where you make your incision...nor are intubations easy. A think neck, neck injury, small airway, or recent trauma can lead to losing the patient...alas. Nor is this malpractice, merely a recognition that some things are difficult technically, even in the best of hands.