Equine emergency upper airway management

Respiratory distress due to acute upper respiratory tract obstruction is an uncommon emergency in equine practice. However, clinicians should be confident with the approach to this truly life-threatening scenario. Clinical signs are obvious at rest and include increased respiratory effort, loud respiratory noise and recumbency as asphyxiation progresses. Many cases of upper respiratory tract obstruction involve the pharynx or larynx, though obstruction in other regions of the upper respiratory tract and other causes of respiratory distress should be considered. Generally, the obstruction can be bypassed by placing a nasotracheal tube under endoscopic guidance or by making a temporary tracheotomy to ensure a patent airway. Following this stabilisation, further investigation into the cause of airway obstruction can be performed. Endoscopy is usually the most valuable diagnostic tool, though other imaging modalities can be useful. Further empirical treatment is often required, though the specific management will vary depending on the pathology present.