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VetVine Client Care
The Case Of The Stridorous Pit Bull
Emergency & Critical Care
Case contributed by Elisa Mazzaferro, MS, DVM, PhD, DACVECC
A 3 year old neutered male pit bull was presented as a referral for a possible esophageal foreign body. At the time of presentation, he had a slow, deep respiratory pattern with a harsh wheezing, stridorous upper respiratory noise during inspiration. His rectal temperature was 104.7oF at the time of presentation.
We sedated him with a small amount of acepromazine and placed an intravenous catheter while providing flow-by oxygen. His respiratory effort worsened. So, we anesthetized him with propofol and prepared to intubate him with an endotracheal tube.
When I opened his mouth to examine his oral cavity, suspicious that there may be a foreign body lodged in the proximal esophagus or oropharynx, I could not see the arytenoids. The tissue around the arytenoids was hemorrhagic and swollen, obscuring my view for intubation.
What would you do next? What do you think could be causing this?
One approach that I have done - when I cannot visualize the arytenoids - is to pass a long, polypropylene urinary catheter through the arytenoids using digital palpation, then pass the endotracheal tube over the polypropylene catheter into place.
After visualizing the hematoma, I asked the clients if there was a possibility of Vitamin K antagonist rodenticide exposure. The clients insisted there was not, until I performed a prothrombin time, and found that it was too high to register. I asked again, and finally, the husband said "Well, I did put poison out to kill the raccoons a week ago." Lightening bolts were shooting out of his wife's eyes after that comment :).....
We immediately administered 15 ml/kg IV fresh frozen plasma as rapidly as possible, and once the plasma was in, I performed a temporary tracheostomy.
The temporary tracheostomy tube was in place for 96 hours, after which time the laryngeal hematoma decreased in size, allowing normal inspiration without evidence of stridor or obstruction.
This was an uncommon presentation for rodenticide toxicity but is has been reported in the literature. Never a dull moment in the ER, is there?! Note to self ... you've always got to be prepared ... like a Boy/Girl Scout! :))
Originally posted May 12, 2013