Bone Fragment Leads to Mother of all Close Calls

 |  Feb 25th 2010  |   23 Contributions




Special note for veterinarians (and other interested people) at the end of this post.

You would think that in my line of work, especially when I work at the emergency hospital, I save animals' lives every day (or night). No doubt, all veterinary teams help animals every day. But it is not every day that my team and I treat an animal that is about to die and make it live instead.

Two nights ago a team of nurses and I unequivocally saved a dog's life*. She was suffocating.

The dog's owner stated that his mother liked to feed bones to the dog. The family had a barbeque on Sunday. The dog had been working on leftover bones since the barbeque. The owner got home from work on Tuesday evening and found his dog struggling for air. He suspected that his dog was choking on a bone.

When the dog arrived at the emergency hospital she was about to die. She was fighting to breathe. Bloody saliva trailed from her mouth. The nurses administered supplemental oxygen and placed an IV catheter. We immediately sedated the dog (struggling for air causes increased bodily oxygen demand; sedation reduces struggling). I attempted to evaluate the dog's mouth but handling the area was too painful, even with sedation, for the dog to tolerate.

We administered a surgical anesthetic (propofol) to the dog and I finally got a good look in her mouth and down her throat. The owner was right. There was a foreign object obstructing the dog's airway. The bone fragment was in the dog's trachea (windpipe). It was seriously wedged in, and it was big enough to choke a horse. The bone's diameter was greater than that of the dog's trachea, and the dog was able to breathe at all only because the fragment had distorted the windpipe into an unusual shape that allowed small amounts of air past the bone's margins.

The bone fragment somehow had gotten past the larynx (the voice box, which is the opening to the windpipe). The larynx and the back of the throat were horribly swollen.

I experimented with a number of different forceps but they couldn't grip the bone well enough to extract it through the larynx. Needle nose pliers (I'm not kidding) couldn't reach the bone. My biggest fear was that I would inadvertently push the bone deeper into the trachea while trying to retrieve it. For a moment I thought that we would have to perform a tracheostomy and to cut through the neck to retrieve the bone.

After what seemed like an eternity (but probably only amounted to a minute or two) I managed to get a good grip on the bone. It was extricated with gentle, constant traction. The imminent crisis was over, but the dog was not out of the woods. Several tiny bone chips and pieces of plant matter were scattered around the back of her throat. These posed a threat. They could be aspirated into the lungs and cause a fatal pneumonia. The larynx was severely swollen. This could compromise breathing later in the night.

We suctioned all of the visible bone fragments from the area and administered steroids and antihistamines to bring down the swelling. Intravenous antibiotic therapy was implemented to guard against pneumonia. The dog spent the next several hours in an oxygen cage. Eventually she breathed well without oxygen supplementation. She went home in the morning.

The nurses who worked with me on this case were every bit as responsible for saving the dog's life as I was.

Photos: 1) Next time, chew your food. 2) Working. Haven't even had a chance to start fluids yet. 3) Morning. All's well that ends well!

Note to veterinarians (and anyone who's interested): This dog was turned away at closing time from another facility before she came to the emergency hospital. It is amazing that she didn't die en route. California law states that critical patients must be stabilized prior to transit. This dog clearly was not. What are your thoughts on this?

And let's take it one step deeper. This dog was a seven-year-old intact Pit Bull whose owner looked like a member of MS-13. Do you think she would have been turned away if she were a one-year-old spayed Lab brought in by a person wearing a suit?

*I concede that the long term survival of the dog is not absolutely guaranteed. See notes in post.

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