How do I handle high-risk swallowing cases without freezing up?

The fear around aspiration cases is not a weakness in you. It is your mind taking the stakes seriously, because the stakes are serious. A clinician who felt no extra weight with the high-risk cases would be more dangerous than you. Let the fear tell you what it is really saying: this matters, so be careful and be prepared. You have already handled most of what comes your way. The high-risk cases are the edge of your skill, and the edge is exactly where you grow. Do not face them alone or from memory. Lean on your protocols, get a second set of eyes when you can, and keep learning the specific things that scare you until they are more familiar. Preparation is how fear turns into readiness. No decision here is ever perfectly certain, and part of the job is acting wisely inside that uncertainty. You gather the information, you follow good practice, you make the call, and you accept that you cannot guarantee every outcome. Do the work carefully and let that be enough. Over time, the cases that freeze you now will become the ones you are known for handling well.