Well, the poor nurse in the ER couldn’t explain it, my PCP wasn’t there and didn’t care to try to re0create the situation, so wouldn’t speculate.
I showed up at the ER with blood in stool (dark red). Was given the make-em-happy-but-no-memory shot and 2 nurses show up with a glass of water and a tube.
The fact that I remember this tells you something went wrong.
What I became aware of was a tube being shoved up my nose while I was to swallow lots of water (the second nurse was a trainee). After about 5 tries, 3 glasses of water, and blood on the gurney, they gave up.
What it felt like was the tube was hitting a bone spur - either on the top of the spine or on the interior of the skull. The nurse reported that, although that couldn’t be what it was, it did seem like it to her as well. With the skull upright, the blockare seemed to be at the rear of the skull at a level even with the mustache.
The Supervisor came by to see what was taking so long and I suggested that maybe we should try a new operator. The Supe’s remark was that the nurse in charge was the best at this on the shift (which would explain the assignment of the trainee to her.
This was about 10 years ago and there has been no reason for anyone to repeat the process, and I’m not going for a cranial MRI or CT over it.
A deviated septum or deformed concha turbinate or some such thing. Can you breath freely through both nostrils? Did they try one then the other? It sounds like they were passing a naso-gastric tube, trying to thread it through your nose & down the esophagus, as opposed to a nasal-tracheal intubation, which is passing an endotracheal tube through the nose, pharynx, then into the trachea where it is sealed off with an inflatable cuff. That’s the sort of thing that’s never done to an alert patient. Without looking at images, and without being there, I can’t tell you for sure what was wrong, but in my experience it is very rare to not be able to pass an NG tube through one nostril or the other. NG tube placement is a routine procedure. You don’t say whether they ever got it down. I’ve seen patients insert their own NG tubes.
After about 5 tries (plus however many I didn’t remember), they gave up.
Yes, IIRC, both nostrils were tried; I can breathe equally well in either - there has never been an issue.
In the last 3-4 years, I have developed an inability to swallow large pills - those “horse pill” multi-vitamin/mineral thing I used in lieu of nutritious food have to be cut or crushed - otherwise they hang somewhere where I can (barely) re-regurgitate them.
This occurs 5-6" below the spot where the tube (heading for stomach, to be used by a scope of some sort) would hit whatever it was.
So:
Expert technician attempting to insert a simple tube approx. 30" long through nose into stomach.
Process is repeated long after the patient has burned off the happy-but-wont-remember drug
The tube came out bloody - I remember pointing out the bit of blood on the gurney.
The obstruction was always felt at the same spot.
I just tried to follow the anatomy of the various bits pertaining to “pharynx”. Now I remember why I wasn’t attracted to medicine…
The sinus is normally a bunch of narrow tubes formed between the “conchae”. They have to open up a bit to let the tube through.
Sure, its some sort of unusual growth.
The tubes shapes are like finger prints or ears, all different shapes in different people,
so its possible the tubes don’t form a straight enough channel,
Also possible its an extraneous growth in the membranes, cause could be congenital, injury (various causes- infection parasite, bone spur… ), virus (like a wart) or genetic (like a mole.)
Or a bone/cartilage spur could be the cause directly.
It is a rare occasion that difficulty dropping an NG tube is something anatomical. Lack of skill/experience of the one doing the procedure is much more likely.
It is not as straightforward as it may seem. There are weird angles to navigate and some “aiming” involved that, at first, seems counter intuitive. It takes a significant amount of practice, and even then some never quite get good at it.
I should add that I’ve done hundreds (well, at least one hundred :)) of these.
mmm
ETA: The appearance of blood after repeated attempts is very typical
This was UCSF - a teaching facility. Being something of a medical outlier and living 1/2 mile away, I became more familiar with the group than I would have liked. The fact that the operator was the one chosen to train the newbie, plus the super’s re-iterated support makes me think this was not typical.
What is it that separates the conchae? Is it a single sac which folds over on itself, or are there rigid separations?
For a weirdness - my Eustachian tubes seem to be permanently blocked - I tries massive Amoxicillin for about a week. For a period of 10 seconds, I could feel air circulating through one ear and into the sinus. It promptly closed back up and has never repeated.
The trick of pinching the nostrils and exhaling to “pop” one’s ears (equalize pressure) has never worked.
Could have the tube found the opening of the Eustachian?