Choking Fit
A choking attack, medically also known as asphyxia, is an acute and life-threatening emergency in which the oxygen supply to the organism is interrupted by a blockage of the airways. In dogs and cats, this is a condition that requires immediate action, as irreversible brain damage or death can occur after only a few minutes without oxygen. The pathophysiology of a choking attack is based on the interruption of gas exchange in the lungs, which leads to a lack of oxygen (hypoxia) in the blood and consequently in all tissues. At the same time, the carbon dioxide concentration (hypercapnia) in the blood increases, leading to respiratory acidosis. The anatomical features of the upper airways in dogs and cats, especially the relatively narrow larynx area and the different configuration of the pharynx compared to humans, make these animals particularly susceptible to certain types of airway obstruction.
Causes
The causes of choking fits in dogs and cats are diverse and can be categorized in various ways. Foreign objects are the most common cause. Dogs, especially greedy eaters, often choke on bones, toy parts, balls, or sticks that can get stuck in the throat or enter the trachea. For cats, small toy parts, threads, or blades of grass are often the cause of obstruction.
Anatomical peculiarities of certain breeds significantly increase the risk of choking fits. Brachycephalic (short-headed) breeds such as Pugs, French Bulldogs, or Persian cats suffer from Brachycephalic Airway Syndrome, characterized by narrowed nostrils, an elongated soft palate, and a collapsed larynx. These anatomical anomalies lead to chronic breathing impairment and increase the risk of acute choking fits, especially during stress, physical exertion, or high ambient temperatures.
Allergic reactions can also lead to life-threatening airway swelling. Insect bites, certain medications, or foods can trigger an anaphylactic reaction accompanied by angioedema, which narrows the airways. Traumatic injuries to the neck or chest, such as from accidents or bite wounds, can compress or damage the airways, leading to airway obstruction.
Less commonly, tumors in the airway, laryngeal paralysis, or neurological disorders affecting the respiratory muscles can also lead to choking. In older animals, laryngeal paralysis should also be considered as a cause, especially in larger dog breeds such as Labrador Retrievers or German Shepherds.
Symptoms
- Agitation of the animal
- Pawing at the mouth to remove the foreign object
- Abnormal breathing sounds
- Cough
- Increasing pallor or bluish discoloration, especially of the oral mucosa
- Unconsciousness
- Without constant oxygen supply, the body can only survive for a few minutes.
The symptoms of a choking attack usually develop rapidly and are dramatic. The affected animal initially shows signs of respiratory distress and panic. It opens its mouth wide to gasp for air and often adopts a stretched head and neck posture to open the airways. Breathing is difficult, noisy, and may be accompanied by gagging, cough, or rattling. Many animals show a characteristic gesture of stroking their paws over their mouths as if to remove a foreign object.
As oxygen deprivation progresses, cyanosis occurs, a bluish discoloration of the mucous membranes, particularly noticeable in the gums and tongue. This discoloration is a sign of critically low oxygen levels in the blood. Breathing becomes increasingly labored, with animals using accessory respiratory muscles, evident in pronounced flank movement and dilation of the nostrils.
The animal becomes increasingly restless and anxious. As hypoxia progresses, coordination disorders, weakness, and eventually unconsciousness can occur. Without rapid intervention, respiratory arrest follows, leading to cardiac arrest and death within a few minutes. The time to irreversible brain damage is very short in pets, about 3–5 minutes after the onset of complete oxygen deprivation.
In partial airway obstructions, the symptoms may be less dramatic and develop over a longer period. Here, the animals may only show intermittent respiratory distress, chronic cough, or reduced exercise tolerance. However, these symptoms should be taken just as seriously, as they can develop into an acute choking attack at any time.
First Aid
- If you can see the foreign object, try to pull it out. Reach resolutely into the oral cavity; it is unlikely that your pet will bite you if your fingers are clearly inside the mouth. Be careful not to push the foreign object deeper into the airways.
- If you cannot see a foreign object, refrain from manipulating the oral cavity.
- Try to see if a forceful exhalation can expel the foreign object by applying short, firm pressure to the side of the chest wall several times. Short pressure impulses on the abdomen with the flat hand can also achieve this effect on breathing.
- Repeatedly check the oral cavity to see if the foreign object has moved and is now possibly visible and can be removed.
- If you cannot remove the foreign object this way, hug or embrace (cat) your pet from behind immediately behind the ribs and lift the abdomen forward and upward with a short, quick jerk (—> Heimlich maneuver).
- Repeat the maneuver 5 – 6 times.
- Placing the animal over a chair or armchair backrest immediately behind the ribs also builds pressure for exhalation and can be helpful.
- Be careful not to use too much force to avoid causing injuries to the ribs or internal organs of the abdomen (liver!).
- If there are still smaller foreign objects or food remnants in the airways, place your animal on its stomach so that a sloping plane is created from the abdomen over the chest to the mouth. The abdomen and pelvis are the highest point, and the mouth opening is the lowest point. The slope must be pronounced. The trachea should be directed downward at an angle.
- Gently pat the back. You can also take small animals on your lap and bend the animal’s upper body slightly forward.
- The mouth opening should always be the lowest point. However, do not apply too much pressure on the abdomen to avoid pushing out stomach contents.
- If your animal loses consciousness, begin resuscitation measures (—> Resuscitation).
If you are not successful, go to a veterinarian immediately. In the event of respiratory arrest, cardiac arrest will also occur after about 5 minutes.
Even if you are successful, you should still take your animal to a veterinarian immediately.
Diagnosis
The diagnosis of a choking attack is primarily clinical based on the characteristic symptoms and the acute course. In the emergency situation, the immediate intervention to restore breathing is the priority, not the diagnostic workup. Once the animal is stabilized, the veterinarian will take a thorough history to identify possible causes. Information about previous activities, access to foreign bodies, or known underlying diseases is particularly important.
The clinical examination includes a careful inspection of the oral cavity and pharynx, whereby a laryngoscope can be used for better visibility in unconscious animals. In awake animals, this examination is often difficult due to the stressful situation and should be performed under sedation as soon as the animal is stabilized.
Imaging procedures such as X-rays of the thorax and neck area can help to locate foreign bodies or identify other causes such as tumors or fluid accumulations. Computed tomography (CT) and magnetic resonance imaging (MRI) offer a more detailed representation and may be indicated in complex cases.
Bronchoscopy is both a diagnostic and therapeutic procedure. With a flexible endoscope, the airways can be viewed directly, allowing precise localization and often removal of foreign bodies. At the same time, tissue samples can be taken for histological examination if tumors or inflammatory diseases are suspected.
Laboratory tests such as blood gas analyses can quantify the extent of respiratory impairment and are important for monitoring the success of therapy. If allergic reactions are suspected, specific serological tests can be performed to identify the triggering allergens.
Further veterinary measures
The therapy for a choking attack requires quick and decisive action. In the acute emergency situation, the first priority is to restore the patency of the airways. If there are visible foreign bodies in the mouth or throat, a careful attempt should be made to remove them, taking care not to push the foreign body deeper into the airways.
The Heimlich maneuver, adapted to the anatomy of dogs and cats, can be life-saving for foreign bodies in the airways. Depending on the size of the animal, it is either held with its back against the helper’s chest or placed on its side. Short, forceful thrusts to the abdomen just behind the rib cage are used to try to expel the foreign body from the airways by the air pressure generated. In small animals, the force must be dosed accordingly to avoid internal injuries.
If the animal is already unconscious, modified resuscitation measures can be initiated. After checking and clearing the airways, gentle mouth-to-nose ventilation can be performed, keeping the animal’s mouth closed and ventilating through the nose. If there is no heartbeat, chest compressions are also necessary.
In the veterinary practice or hospital, advanced measures are available. Oxygen therapy is an important supportive measure that can be administered via various systems such as oxygen cages, masks, or nasal oxygen probes. In severe respiratory distress, sedation may be necessary to reduce the animal’s stress and allow further diagnostic or therapeutic measures.
In critical cases, intubation and mechanical ventilation may be required. If intubation is not possible due to an obstruction in the upper airway, an emergency tracheotomy can be performed, creating a temporary access to the trachea below the blockage.
Bronchoscopy allows not only the diagnosis but also the removal of foreign bodies under visual control. With special instruments, foreign bodies can be grasped and removed, while at the same time an assessment of possible mucosal damage is carried out.
After the acute intervention, careful monitoring is necessary, as complications such as laryngeal edema, aspiration pneumonia, or reperfusion injury can occur. Antibiotics can be used prophylactically to prevent secondary infections, especially if there are injuries to the airway mucosa.
Prognosis and aftercare
The prognosis after a choking attack depends largely on the duration of oxygen deprivation, the underlying cause, and the speed of intervention. With early and successful elimination of the airway obstruction without a prolonged hypoxic phase, the prognosis is usually good. However, animals that have been without adequate oxygen for more than 3–5 minutes may suffer permanent neurological damage.
Aftercare includes careful monitoring of respiratory function and general condition. In the first 24–48 hours after the incident, there is an increased risk for the development of laryngeal edema or aspiration pneumonia. Regular clinical check-ups, possibly supported by X-rays of the thorax, are important to detect complications early.
In animals that have received a tracheotomy, particularly intensive aftercare is required. The tracheostomy site must be cleaned regularly and monitored for signs of infection. The tracheostomy tube is removed as soon as normal breathing through the upper airways is possible again.
In the long term, it is important to address the underlying cause of the choking attack. In brachycephalic breeds, surgical correction of anatomical abnormalities can be considered to reduce the risk of future seizures. In the case of foreign body aspiration, preventive measures should be taken, such as avoiding unsuitable toys or feed.
The psychological effects of a choking attack should not be underestimated. Both the animal and the owner can be traumatized. Some animals develop fear of certain situations or objects that are associated with the incident. A gentle reintegration into normal everyday life and, if necessary, behavioral therapy measures can be helpful.
Summary
The choking attack in dogs and cats is an acute, life-threatening emergency that requires immediate action. The most common causes are foreign bodies in the airways, anatomical features in certain breeds, allergic reactions, and traumatic injuries. The symptoms typically develop rapidly and include respiratory distress, gagging, cough, cyanosis, and, in advanced stages, unconsciousness.
The diagnosis is primarily clinical, with immediate intervention to restore breathing being the priority in the emergency situation. After stabilization of the patient, further diagnostic measures such as bronchoscopy or imaging procedures can be performed to identify the exact cause.
Therapy includes first aid measures such as the Heimlich maneuver, removal of visible foreign bodies, and, if necessary, resuscitation measures. In veterinary care, oxygen therapy, bronchoscopy for foreign body removal, and in severe cases intubation or tracheotomy are used.
The prognosis is good with rapid intervention, with the risk of permanent neurological damage increasing with the duration of oxygen deprivation. Aftercare includes monitoring for complications and addressing the underlying cause to prevent future seizures.
Outlook on current research
Research in the field of choking attacks in pets focuses on several key areas. An important focus is on improving emergency care through innovative techniques and equipment. Miniaturized bronchoscopes and special gripping tools enable gentler and more precise removal of foreign bodies from the airways. Portable oxygen concentrators for home use could improve the initial care of at-risk patients in the future.
In the field of genetic research, the causes of anatomical abnormalities in brachycephalic breeds are being investigated. The aim is to reduce the extreme manifestations through selective breeding programs and to promote healthier airway structures. In parallel, minimally invasive surgical techniques are being developed to correct existing anatomical problems more effectively.
Telemedicine is also gaining importance in veterinary medicine. Special apps and online platforms can help pet owners to recognize emergency situations more quickly and to carry out correct first aid measures. Virtual training courses with simulations of emergency situations improve the preparation of pet owners for such events.
New materials and designs for pet toys and feed are being developed to reduce the risk of foreign body aspirations. These products take into account the specific chewing and playing behavior of different animal species and breeds.
The exploration of biomarkers for tissue damage after hypoxia could enable a more precise prognosis in the future. Through the early identification of animals with an increased risk for neurological sequelae, more targeted neuroprotective therapies could be initiated.
Frequently asked questions (FAQs)
- How do I recognize a choking episode in my pet?
A choking attack manifests as sudden respiratory distress, gagging, cough, wide-open mouth, panic, and the characteristic pawing at the mouth. With progressive oxygen deprivation, the Bluish mucous membranes (cyanosis). - Which objects most frequently cause choking episodes in pets?
For dogs, it’s often balls, sticks, bones, and toy parts. Cats more frequently choke on threads, small toy parts, or blades of grass. Food chunks can also lead to blockages when pets eat greedily. - Is the Heimlich maneuver suitable for all pets?
The Heimlich maneuver can be used on dogs and cats, but it must be adapted to the size and anatomy of the animal. For very small animals, there is a risk of internal injuries, so the force must be appropriately adjusted. - Why are brachycephalic breeds particularly at risk for choking episodes?
Brachycephalic breeds have narrowed nostrils, an elongated soft palate, and a constricted larynx due to their breeding characteristics. These anatomical features lead to chronic breathing impairment and increase the risk of acute choking episodes. - Can a choking episode lead to permanent damage, even if the animal survives?
Yes, if oxygen deprivation lasts longer than 3-5 minutes, permanent neurological damage can occur. This can range from mild cognitive impairments to severe neurological deficits. - How can I prevent choking episodes in my pet?
Avoid unsuitable toys and chew items that can break into pieces. Supervise your pet while playing and eating. For greedy eaters, special food bowls or food toys can help slow down food intake. - Should I always consult a veterinarian after a choking episode, even if my pet seems to have recovered?
Yes, even if the foreign object has been removed and the animal appears to be breathing normally again, a veterinary check is important. There may be injuries to the airways or remaining particles that could lead to complications later. - What is a tracheotomy and when is it performed?
A tracheotomy is a surgical procedure in which an access to the trachea is created below the larynx. It is performed as an emergency measure when the upper airways are blocked and cannot be cleared. - Can aspiration pneumonia occur after a choking episode?
Yes, if saliva or foreign material enters the lungs during the choking episode, aspiration pneumonia can develop. This bacterial infection requires antibiotic treatment. - Are there special first aid courses for pet owners?
Yes, many veterinary clinics, veterinarians, and animal welfare organizations offer special first aid courses for pet owners, which also include training on the correct procedure for choking episodes.
Literature
- Löwe, G. and Löwe, O., 2021. Emergencies in dogs and cats – A veterinary guide. Kynos-Verlag. 208 pp.
- Rozanski, E. A., Chan, D. L. (2021). Small Animal Emergency and Critical Care Medicine: Self-Assessment Color Review. CRC Press. ISBN: 978-0367504656.
- Sumner, J. P., Rozanski, E. A. (2022). Update on Respiratory Emergencies in Small Animals. Veterinary Clinics of North America: Small Animal Practice, 52(3), 715-730. https://doi.org/10.1016/j.cvsm.2022.01.002.
- Dupré, G., Heidenreich, D. (2023). Brachycephalic Obstructive Airway Syndrome: Management and Surgical Techniques. Veterinary Clinics of North America: Small Animal Practice, 53(1), 95-114. https://doi.org/10.1016/j.cvsm.2022.09.002.
- Adamama-Moraitou, K. K., Pardali, D. (2021). Acute Airway Obstruction in Dogs and Cats: Pathophysiology, Diagnosis, and Management. Journal of Veterinary Emergency and Critical Care, 31(3), 293-312. https://doi.org/10.1111/vec.13058.
- Kelmer, E., Scanson, L. C. (2022). Advances in Emergency Airway Management in Small Animals. Veterinary Clinics of North America: Small Animal Practice, 52(6), 1389-1406. https://doi.org/10.1016/j.cvsm.2022.07.008.
Golden Retriever with a ball in its mouth