On the topic of choking… Dr. Jeremy Libby – ER veterinarian

While working emergency shifts over the years it is always concerning to hear that a pet may be choking. There are many conditions that can lead to symptoms that are described as choking. Some of these conditions can become life threatening very quickly while in other cases the symptoms may seem very dramatic with little or no danger to the pet. I will review some of the primary causes of such symptoms and discuss which cases may require a quick trip to the emergency room for potentially lifesaving intervention.

Laryngeal and tracheal (upper airway) and esophageal (upper GI) obstructions:   The larynx is the opening from the mouth into the windpipe (trachea). The windpipe travels into the lungs. If this gateway into the windpipe or the windpipe itself is blocked by an object or swelling the pet may not be able to get enough oxygen. In these cases there may be a history of the pet chewing on a bone, treat, ball or toy immediately before the onset of symptoms.

These cases can be very life threatening and may require immediate sedation or anesthesia for removal of an object and to provide oxygen. Pets with these conditions tend to be gagging and hacking constantly with no rest and often times are frothing at the mouth or salivating and their gum color may become purple or blue. In rare cases performing a tracheostomy (surgical opening of the windpipe below the obstruction to allow air into the lungs) or endoscopy (scoping) of the trachea or esophagus to attempt to grasp and remove the obstruction may be required.

These symptoms can also occur if an object blocks the esophagus (tube from the mouth to the stomach). Generally the degree of choking is not as severe as when the airway is blocked, but sometimes objects in the esophagus can compress the trachea/windpipe and cause severe symptoms of choking.

With both airway and esophageal obstructions, the Heimlich maneuver can be attempted. With the head down and the hind limbs up, the sternum (breastbone) or ribcage may be compressed in an attempt to expel the obstruction. This is generally not recommended at home unless it is apparent that the pet cannot breathe and is imminently life threatened.

Laryngeal Paralysis: In large breed, older dogs (and rarely in cats) paralysis of the nerve that is responsible for opening the larynx (gateway to the trachea/windpipe) can occur, which causes narrowing of the glottis (vocal chords and the space between them). This disorder causes poor oxygen flow into the lungs and is associated with exercise intolerance and increased breathing effort with wheezing (stridor) upon inhalation. It is common for dog owners to notice a loss of bark or voice change in their pets. These dogs are prone to overheating and choking on phlegm or vomit because the airway does not seal completely.

Pets with laryngeal paralysis oftentimes require sedation and oxygen therapy until corrective surgery can be performed to allow more complete opening of the airway.

Brachycephalic Syndrome: Brachycephalic (broad head, short nose) dogs include species such as the English Bulldog, Boston Terrier, Pug, Pekingese, Boxer, Lhasa apso, and Shih Tzu. Brachycephalic cats (Persians and Himalayans) can uncommonly require treatment. These breeds can have anatomical malformations of the nostrils (too narrow), soft palpate/roof of mouth (too long), laryngeal saccules (everted and swollen tissue of the larynx), trachea/wind pipe (too narrow), among other airway abnormalities. Upper airway obstruction with choking and poor air flow can be caused by any combination of those abnormalities. In many cases the affected animals may require surgical intervention to remedy anatomical airway abnormalities to provide better exchange of air.

Any brachycephalic animals with symptoms of upper airway blockage, choking, or difficulty breathing should be assessed immediately as these symptoms can become threatening without rapid supportive care.

Tracheal Collapse: Collapse of the windpipe/trachea is a condition that occurs most commonly in toy breed dogs. The Yorkshire Terrier is the most common breed affected. The windpipe is generally rigid, but in these pets it can become weak and collapse on itself due to pressure from inhalation. A harsh cough that worsens with activity or stress and sounds like a “goose honk” is commonly described.

These patients are oftentimes treated with sedation, anti-cough (antitussive) medications, oxygen, and anti-inflammatories to reduce swelling. Stress can create a vicious cycle and worsening of the condition so keeping the pet as calm as possible and getting them into the hospital is recommended.

Kennel cough (infectious tracheobronchitis): Viral and bacterial infections of the upper airways of dogs and cats can cause a harsh hacking, gagging cough. These infections are most commonly acquired at kennels/boarding facilities, pet shops, shelters, dog parks and animal hospitals. Owners often describe the cough as sounding like the pet has something caught in their throat and they are trying to hack it up. Sometimes a small amount of white or clear froth, foam or thick phlegm is produced after coughing and there is confusion as to whether or not this material has been vomited up or coughed up. Symptoms usually occur 3-10 days after exposure to the infectious agents. While kennel cough infections create a harsh “choking” cough, these pets are generally stable and eating and drinking with some rest between coughing episodes.

Kennel cough usually has to run its course because it usually begins as a viral infection, but antibiotics and anti-cough (antitussive) medications can reduce severity and longevity of the symptoms and reduce the potential for pneumonia (lower respiratory infection) in young and old pets.

Reverse sneeze syndrome: The reverse sneeze syndrome is oftentimes described as a “hyperventilation” with an audible inspiratory (inhalation) and expiratory (exhalation) component without a forceful expiratory cough. These pets are often times snorting or wheezing upon inhalation and they appear to be unable to “catch their breath.” While this syndrome is dramatic and appears threatening, it tends to spontaneously resolve within moments with no long term ill effect. Irritation of the nasal passageways or the back of the throat (pharynx) is the usual cause.

These are just some examples of conditions that may cause concern for choking in your pet. While some conditions are not necessarily life threatening and may not constitute a true emergency (such as kennel cough or reverse sneeze syndrome), others may require rapid intervention to stabilize your pet and offer life saving treatments (upper airway obstructions, laryngeal paralysis, brachycephalic syndrome, tracheal collapse). The safest approach is to always utilize our emergency services and have a veterinarian assess your pet if it is having symptoms of choking or difficulty breathing. It is much safer to err on the side of caution with breathing difficulties.

Dr. Jeremy Libby, Hospital Director, North Charleston Veterinary Emergency Care


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