Kerry Doolin

Replying to Aileen D. 20/08/2025 - 16:15

Hi Aileen,
I know it feels counterintuitive, because we want to give something anti-inflammatory, but that’s not really the issue in traumatic brain injury. The problem isn’t inflammatory swelling like with meningitis or a tumour—it’s cellular injury, bleeding, and impaired autoregulation. Large trials like CRASH showed that steroids actually increase mortality and don’t improve neurological outcomes. That’s why all current guidelines advise against their use. Steroids do have a role in vasogenic oedema from tumours or meningitis, but they are specifically harmful in head trauma.

Have a look at these:
1. https://pmc.ncbi.nlm.nih.gov/articles/PMC7043302/pdf/CD000196.pdf
2. https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-025-02803-5
3. https://www.bmj.com/content/316/7128/396

Replying to Shannon Thorell 19/06/2025 - 12:56

Hi Shannon,
Thanks for your question. I don’t have a particular brand I use. I do have a few things to consider though:
1. Type of nebuliser to buy:
– Avoid ultrasonic as they can overheat drugs such as adrenaline.
– Mesh type are good but too expensive.
– Aim for a Jet nebuliser, like this one (https://www.amazon.com.au/Compressor-Nebuliser-Nebulizer-mouthpiece-respiratory/dp/B0BCKN1WXW/ref=asc_df_B0BCKN1WXW?mcid=3cc698d73f393b01ba5b40206bf8403e&tag=googleshopdsk-22&linkCode=df0&hvadid=712246395771&hvpos=&hvnetw=g&hvrand=14322623079672732001&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9071778&hvtargid=pla-1945624289978&psc=1&gad_source=1).
I do not spend too much as parts get lost often and the unit needs replacing.

2. Think about compatibility with drugs:
Adrenaline: used for laryngeal oedema or severe asthma-type reactions. Can be nebulised safely.
Salbutamol (albuterol): used in feline asthma or reactive airway disease.
Avoid oil-based compounds — can cause fatal lipid pneumonitis in cats and dogs.

3. Cleaning and Maintenance
After each use, rinse the medication cup, mask, and tubing with warm soapy water. Rinse thoroughly and air dry. After a patient – disinfect removable parts. Don’t submerge the compressor/machine.

4. Risks and Precautions
Cross-contamination needs to be considered – Strict cleaning protocols are essential if nebuliser is reused between patients.
Stress – Animals may resist masks or chambers; consider sedation or use in oxygen cages.
Bronchospasm – Drugs like adrenaline can paradoxically worsen symptoms if overused – monitor closely.
Aerosol spread of pathogens – Nebulisation can aerosolise infectious agents (e.g. Bordetella). Avoid use in open/shared spaces.

5. Additional Tips
For cats and small dogs: Paediatric masks or infant spacers with adapters work well, but I commonly prefer to use with a patient in an oxygen kennel (O2 off) to deliver. Works well for stressed or ICU patients.

Replying to scott@vtx-cpd.com 05/03/2024 - 14:05

Hi all,

I like to find reasons to use TXA where I can! I had a greyhound recently that was on TXA prior to dental extractions but haemorrhaged significantly post-op. On top of the IV TXA I gave we used it as a mouth wash –> who knows which was more effective or if any, but bleeding subsided within 60 minutes so I felt positive!

Replying to Lucy Baker 13/03/2024 - 11:23

Hi Lucy,

Thanks for listening to the lecture and doing the MCQs. It looks like you’ve well noticed a typo in the hyperkalaemia question –>
1. Which of the following drugs are indicated to promote the transcellular shift of potassium in hyperkalaemia?
a. Regular insulin
b. Glucose
c. Sodium bicarbonate
d. Calcium gluconate – this was down as the correct answer – but the typo is in the question. It should be “Which of the following drugs are NOT indicated to promote the transcellular shift of potassium in hyperkalaemia?

I hope Neus answered your queries on Hypernatraemia. The slight variation from my and Neus’ answer is what you consider normal Na. I tend to use the middle of the reference range, but you can use the low end or high end –> the difference between these is negligible.

I hope this helps.

Hi Sybil,
This sounds like a really sick dog. Those sound like very extensive wounds. Any chance on top of the infection you had some MODS with hepatic dysfunction – that would also make your glucose very hard to control. Managing the hypoglycaemic patient can be hard or even impossible when the underlying cause is not controlled – so despite best efforts it can be fruitless unfortunately.

When you have a severely or refractory more so hypoglycaemic patient, running dextrose over 5-10% can be required. Just remember that if you need solutions over 7.5% of dextrose, you need a central line to be placed to prevent injuries and issues related to the high osmolality of the solution.

Replying to Ornella R. 28/02/2023 - 13:57

Hi Ornella,

That is a really great question – I am so glad to read about good antimicrobial stewardship. Short answer is I am very conservative with antibiotics. When I am concerned a patient has aspirated (from GI signs such as vomiting or regurgitation), I check to see if there is fever r changed SPO2 (this can often be normal). Though I do the following:
– check CRP
– ideally perform thoracic radiographs too but CRP alone can save money

There is some good evidence for using CRP to guide antibiotic use antibiotic use is aspiration pneumonia vs pneumonitis:
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9151469/pdf/JVIM-36-1082.pdf
2. There is another good one in JVECC somewhere.

Hi Ornella,

This is an interesting phenomena. However, very important as it means we have ti be very cautious with blood transfusions in cats. There are multiple factors involved:
– the reduced O2-carrying capacity of blood in anaemia –> tissue hypoxia –> normal compensatory mechanisms initiated to manage this.

Two things occur and both lead to reduced afterload:
1. Peripheral vasodilation due to low haemoglobin
2. Reduced systemic vascular resistance due to reduced blood viscosity

When afterload is reduced there will be an appropriate increase in stroke volume and cardiac output AS COMPENSATION. This progresses in chronic anaemia (common in cats). So when the patient is transfused, the body takes time to reduced this increased cardiac output. Additionally in chronic anaemia, there can be remodelling of the left ventricle leading to thickening as a result of this compensation. So unless haemorrhage, the patient needs red cells not volume.

Complicated but hopefully makes sense!

Cheers,

Kerry.

Hi Ornella,

These are some great questions.

Let’s start with sepsis. The antibiotics we choose in sepsis are going to be mostly like how we choose antibiotics for other infections. These are the factors I consider each time I choose an antibiotic:
1. What is the source? So for example, if I am treating septic peritonitis due to a ruptured GI tract or aspiration pneumonia, then my pathogens will likely be enteric such as E. coli or Enterococcus for example. So here I would start with a beta lactam perhaps such as potentiated amoxicillin.
2. Is the patient sick enough in sepsis here to make me want to cover all 4 quadrants very strictly? So if we come back to this septic peritonitis case, I may consider adding a fluoroquinolone. If we have gone down this route it is imperative to obtain cultures so that we can de-escalate ASAP (meaning try to stop one of these drugs if not needed). I always try to start with less antibiotics if possible. Consider that we are often achieving source control with surgery in septic peritonitis whereas with aspiration pneumonia the drugs are doing all the work.
3. Get samples for culture. Hospitalised patients, especially if already on antibiotics before or in ICU have a lot of resistance. We see this commonly in fluoroquinolones and other commonly used drugs.

Now anaphylaxis…..
Pulmonary oedema is not a common feature in anaphylaxis which itself is not common – so we are lucky for that. The big question is what exactly was occurring as you could have had multiple causes:
– non-cardiogenic pulmonary oedema due to histamine release (most commonly what is going on), leading to leaking of the pulmonary endothelium and epithelium causing all this exudation.
– this can progress to ARDS in humans (really hard to diagnose in our patients)
– often can see periods of upper airway obstruction too which can worsen all this.
So treatment is two pronged:
1. treat the anaphylaxis –> a lot of your treatment is very much what I would have done:
– maintain blood pressure with fluid therapy judiciously due to that leakage and rapidly get on a vasopressor. I would reach for norepinephrine or epinephrine as a CRI. Current guidelines recommend either – but take cause as epinephrine has been reported in humans to lead to flash oedema which is what you have already. If you dont have these drugs – dopamine would be my third line.
– antihistamines are appropriate.
– i do use steroids but know they take time to take effect and are not much use in the emergency.
2. treat the hypoxaemia –> with intubated and mechanical ventilation. There is so much fluid in the lung the compliance is terrible so no matter ho hard to do IPPV, they need good positive pressure ventilation on a machine.

Lastly pneumothorax…..
The way to define this in on a DV survey radiograph, tension pneumothorax has mediastinal shift, the reason this is so critical is the vascular structures are compromised reducing venous return which reduces cardiac output. Though – defining this clinically is not so relevant – if the patient is compromised with respiratory distress or hypotension, drain the chest (ideally under little or no sedation). I will see if I can remember the case I saw when I was working with Neus at Glasgow – she might be able to track down the CT images – they were ver interesting.

Hope this helps!