Consider a horse choking to be an emergency, although a veterinarian can usually resolve it with prompt actionSigns of choke include nasal discharge, stretched neck, and attempts to swallow. Photo: Haylie Kerstetter/The HorseEsophageal obstruction, routinely referred to as choke, is considered an equine emergency. It often results from feed or a foreign object getting lodged in the esophagus. Types of feed often associated with choke include hay, grain, and/or beet pulp. However, choking horses can present with a variety of feedstuffs, including treats, as well as nonfeedstuffs (such as wood and shavings). In addition, geriatric horses can be more prone to choke.1-4When a Horse ChokesSome causes of choke include: eating quickly (bolting), dental issues (worn or missing teeth, dental disease), foreign objects, dehydration, and recent sedation.Clinical signs of choke are often associated with the horses inability to swallow, leading to a buildup of saliva and feed in the pharynx that often exits through the nostrils. This results in the classic frothy, feed-tinged nasal discharge seen with these cases. Horses can also exhibit signs of pain similar to colic.Other signs include coughing, stretching out the neck, hypersalivation, agitation, attempting to swallow, inappetance, and a palpable swelling on the left side of the neck.1-4Treating a Horse for ChokeIf you suspect choke, call your vet immediately. The longer an episode continues, the more likely complications could result.1While waiting for your practitioner to arrive, remove feed and water from the stall/pen, and try to keep your horse calm.Veterinarians often start with a thorough physical exam and then administer sedation. Sedation allows passing of a nasogastric tube; this is the best way to confirm choke. In a nonchoking horse the tube passes from the nostril to the pharynx, into the esophagus, and down to the stomach. With a choking horse the tube stops once it hits the esophageal obstruction. Keeping the horses head low during this procedure allows fluid to exit the nostrils and minimizes aspiration.Next steps typically involve performing a gentle water lavage of the obstruction through the tube. If the choke cant be relieved in the field, or there is concern about damage to the esophageal mucosa or aspiration pneumonia, your veterinarian might refer your horse to a hospital for an endoscopic exam and ultrasound.Endoscopy allows practitioners to evaluate the esophageal mucosa for damage or potential secondary complications (such as strictures, etc.). An endoscopic exam also allows visualization of the obstructions cause and gives a continued opportunity to relieve it. In cases of potential aspiration pneumonia, the veterinarian will perform a thoracic ultrasound. In a small percentage of cases, horses need general anesthesia or a few days at the hospital to resolve a choke.Once resolved, practitioners will outline a refeeding schedule and a management plan for your horse.Preventing Future ChokeSteps you can take to help prevent a future episode include: not feeding following sedation (wait until your horse is awake); using a slow feeder if your horse bolts feed; and ensuring regular veterinary dental care.Take-Home MessageIn a perfect world your horse will not experience choke. But if he does, remember to call your veterinarian as soon as possible to help guide you and your horse through this emergency.References1. Chiavaccini L, Hassel DM. Retrospective review of clinical features and prognostic variables in 109 horses with esophageal obstruction. J Vet Int Med. 2010;24:11471152.2. Duncanson GR. Equine oesophageal obstruction: A long-term study of 60 cases. Equine Vet Edu. 2006;18:262265.3. Southwood LL, Wilkins, PA. Equine Emergency and Critical Care Medicine. London: Taylor and Francis Group; 2014.4. Orsini JA, Divers TJ. Equine Emergencies: Treatment and Procedures (Fourth Edition). Pennsylvania: Elsevier Saunders; 2014.