Milo was having a perfectly normal day. He ventured outside as all dogs do, but when he returned, his owner noticed he had more laboured breathing than usual. He noticed Milo’s tongue was swollen and decided to bring Milo to the SPCA for a check-up. On route to the SPCA, Milo’s condition deteriorated fast, by this time his airway was completely obstructed by swelling. Unable to breathe, Milo collapsed just as they arrived at the SPCA.
Code Blue – All hands on deck
A panicked owner ran carrying limp Milo in his arms. Placed in a life or death situation, the SPCA clinical warriors jumped into action. Milo was rushed into theatre. His clinical diagnosis on arrival, unresponsive, complete obstruction of the airway, swollen tongue, advanced stages of anaphylaxis. A life-threatening allergic reaction that occurs when the immune system overreacts to an allergen by releasing chemicals that cause allergy symptoms. Suspected snake bite or an insect sting.
What happened?
On arrival, Milo was shaved at strategic spots to look for puncture wounds. There were no puncture wounds found, which ruled out the possibility of a snake bite. It is more likely an insect sting that caused the reaction, he might have swallowed a bee.
Emergency Veterinary Medicine
The priority was to stabilise Milo by restoring his breathing and to counter the allergic reaction. A whole team, including three veterinarians and a team of paraprofessionals and theatre assistants, raced against the clock to save Milo’s life. Milo was intubated with narrow gauge pipe to restore the flow of oxygen. It bought more time, but it was not enough. Milo’s temperature skyrocketed and he was still in respiratory distress, his anaphylaxis was still advancing at an alarming rate. The team covered Milo in ice packs to bring his temperature down, while the veterinarians needed to improve his breathing and restore better airflow.
In the background, the paraprofessionals and theatre assistants scrambled to get Milo on an intravenous drip. High dosages of adrenaline, antihistamines and anti-inflammatories were injected to counter the allergic reaction. Despite their efforts, Milo was still not responding to the treatment, he was getting worse. At this point, doctors decided to perform an emergency tracheotomy, an incision in the windpipe to relieve an obstruction to breathing. Milo was placed under general anaesthetic for the emergency procedure, which would bypass the swollen areas and restore his breathing.
Clinically induced state
The tracheotomy was successful, Milo could breathe through the pipe in his neck. Once Milo had been stabilised, his temperature-controlled and his breathing restored he was placed in a sedated state overnight. “We kept him in a sedated state to ensure the stress of the whole ordeal did not overwhelm him, the panic of not being able to breathe, he needed a chance to rest and recover,” said Dr Stephanie. Milo was in ICU under observation for the night.
Morning after
On early morning rounds, Dr Stephanie said “When we got to him, he was sitting up, almost as nothing had happened to him. The swelling has gone down a lot, the tongue was still a bit swollen, he is still breathing through the pipe in his airway, but he is looking much better and we expect he will make a full recovery”
Next steps to recovery
On doctors orders, Milo will remain in observation for the next few days. “We need to keep the tracheostomy tube in place until we know for sure the reaction is gone and all the swelling has gone down,” said Dr Stephanie. He is still receiving antihistamines and anti-inflammatories intravenously at lower doses to get the last bit of swelling down. Milo has not started eating yet, so we need to monitor and observe to see that he starts eating again.
After a few days, the tube will be removed and the team will check that there are no complications from the tube in the neck and throat area. Dr Stephanie says “We want to make sure the swelling is completely subsided and he can eat normally”
