INTERVENTION

Provide interventions and supportive care to alleviate any potential confounding factors:

• Fear and anxiety: tranquilize, sedate, or anesthetize if necessary. (See K9 Analgesia and Anesthesia.)
• Hyperthermia: active and/or passive cooling to maintain appropriate body temperature. (See K9 Heat Injury CPG.)

Provide oxygen supplementation while preparing to access and extract the obstruction. Consider that most UAOs are not complete obstructions. Most often, some air can still flow around the obstruction and reach the lungs.

Ensure personnel safety to avoid bite injuries. Do not stick one’s hand into the mouth of a conscious MWD.

Quickly and safely establish a patent airway by removing any obstructive material from the upper airway.

• Suction or wipe the mouth and oropharyngeal area of any excessive secretions or blood that may be contributing to the UAO and to allow for greater visualization. BE CAREFUL to not push the object deeper into the airway.
• Consider providing abdominal thrust maneuver in MWDs with a moveable object located within or rostral to the supraglottic area. Only attempt if the object is known to be lodged in the trachea or larynx and is confirmed to be smooth. DO NOT attempt in MWDs with sharp object obstructions or with known or suspected abdominal trauma.

Abdominal  Thrust  Technique

• Approach the MWD from the rear.
• Reach over top and bear hug the MWD by placing your fist(s) immediately caudal to their xiphoid process.
• Compress the abdomen with five quick upward (craniodorsal) thrusts. When performing the abdominal thrusts, slightly elevate the hind end, while ensuring the MWD’s front feet remain on the ground. Avoid picking up and holding the MWD completely off the ground or holding them upright like a person.
• Check to see if the object was dislodged.
• Repeat 1-2 times. If unsuccessful, immediately move to an alternate airway clearance technique.

Non-Invasive  Extraction  Technique

An alternative to performing abdominal thrusts, with the mouth held open, use large forceps (e.g., Magill) or similar instrument to extract any movable objects or obstructions.

Attempt extraction only under direct visualization of the obstructive material. AVOID performing a blind 2-finger sweep of the oral cavity if the object is not readily visible. This can push the object further down into the airway.

External  Extraction  Technique

Ball-like objects that are causing an UAO can be removed by placing the dog on their back with their head and airway parallel to the floor. Feeling the ball lodged in the throat, place thumbs on each side of the trachea below the ball (toward the body), using the middle fingers to help open the jaw. Push down and out against the ball, ejecting it from the mouth.

If attempts to clear or remove object or obstruction from the airway using the above non-invasive techniques have failed and/or the MWD collapses, immediately proceed to performing a surgical airway (CCT/TT).

Continue to provide oxygen supplementation and/or assisted ventilations, while preparing to perform the surgical airway.

• Partial UAO: Provide artificial ventilation via BVM technique or mouth to snout.
• Complete UAO: Consider needle CCT or tracheal oxygen insufflation to provide oxygen delivery (see Table 1).