Ask VETbytes: What are the treatment aims of head trauma/traumatic brain injury?

This week, we asked VETbytes: “what are the treatment aims when managing a case with head trauma or traumatic brain injury?”. After your initial assessment, our vets recommend the following treatment aims, but first, remember:

Cerebral perfusion pressure = MAP – ICP
If ICP > MAP there is no cerebral perfusion

Optimise MAP
  • i/v fluids
  • +/- blood products
  • +/- vasopressor support
Reduce ICP
  • Avoid hypoxaemia
  • Avoid hypercapnia or hypocapnia
  • Promote venous drainage by elevating the upper body by 15–30 degrees
  • Manage seizures
  • Control pain
  • Reduce cerebral oedema with hypertonic saline or mannitol

To access the full clinical guide for head trauma and traumatic brain injury subscribe to VETbytes for £9.99/month or £99/year or start your free 30-day trial today! BSAVA members receive 33% discount and BSAVA 1st year qualified members 6 months FREE access, click here to find out more.

If you have any questions about using VETbytes, get in touch with the team today.

Ask VETbytes: Acute Haemorrhagic Diarrhoea Syndrome

This week we were asked if antibiotics are indicated in cases of canine acute haemorrhagic diarrhoea syndrome (AHDS)? Our team of vets had the following advice:

  • Routine use of antibiotics is not recommended
  • Treatment of dogs with aseptic haemorrhagic gastroenteritis with co-amoxiclav does not reduce the time to resolution of clinical signs
  • Evidence suggests that the addition of metronidazole is not beneficial
  • Broad-spectrum i/v antibiotics are indicated in immunocompromised or neutropenic patients and in those with suspected sepsis
  • Stop antibiotics as soon as the patient is clinically well


Find more answers to common emergency and critical care questions, when you sign up to VETbytes.
Start your free trial today or subscribe for £9.99/month or £99/year.
BSAVA members receive 33% discount and BSAVA 1st year qualified members 6 months FREE access, click here to find out more.

[3] Unterer, S., Strohmeyer, K., Kruse, B.D. et al. (2011)
Treatment of Aseptic Dogs with Hemorrhagic Gastroenteritis with Amoxicillin /Clavulanic Acid: A Prospective Blinded Study

Journal of Veterinary Internal Medicine;25(5) 973-979
Full text available

[6] Unterer, S., Lechner, E., Mueller, R.S. et al  (2015)
Prospective study of bacteraemia in acute haemorrhagic diarrhoea syndrome in dogs 

Veterinary Record;176(12) 309

[16] Dunowska, M. (2017)
What is causing acute haemorrhagic diarrhoea syndrome in dogs?
Veterinary Record;180(22) 539 – 541
No Abstract available

[17] Ortiz, V., Klein, L., Channell, S. et al. (2018)
Evaluating the effect of metronidazole plus amoxicillin‐clavulanate versus amoxicillin‐clavulanate alone in canine haemorrhagic diarrhoea: a randomised controlled trial in primary care practice
Journal of Small Animal Practice59(7) 398-403

[18] Ziese, A.L., Suchodolski, J.S., Hartmann, K. et al. (2018)
Effect of probiotic treatment on the clinical course, intestinal microbiome, and toxigenic Clostridium perfringens in dogs with acute hemorrhagic diarrhea
PLOS One13(9) e0204691
Full text available

[25] Dean, R. and Perry, R. (2017)
Use of antibiotics in dogs with aseptic haemorrhagic gastroenteritis
In [clinically well dogs with haemorrhagic gastroenteritis] does [systemic antibiotics compared to no antibiotics] [decrease the time to resolution of clinical signs]?
BESTbets for Vets, University of Nottingham
Full text available

[28] Unterer, S. (2017)
Acute hemorrhagic diarrhea syndrome – an update
An urban experience, 42nd World Small Animal Veterinary Association Congress and FECAVA 23rd Eurocongress pp 242-243

Join us at BSAVA Congress – Book your live demo now

VETbytes is delighted to be exhibiting at the upcoming virtual BSAVA Congress 2021, taking place 25-27 March, where we will be showcasing our Emergency and Critical Care (ECC) module.

Join us for live demonstrations of the ECC module during the event and sign up for a free trial of VETbytes during Congress for a chance to win one of three annual subscriptions (each worth £99) or an iPad 10 (32GB)*

*Terms and conditions:

  • One entry per person. One per prize per person. Prizes are non-transferable, non-refundable. Open to UK residents aged 18+
  • To enter the competition you must sign up for a free trial between 08:00 Thursday 25 March and 18:00 Saturday 27 March 2021
  • Closing date for entries is 18:00 Saturday 27 March 2021
  • Winner will be chosen at random from free trial subscribers between the above dates
  • Winners will be notified by email no later than Monday 29 March 2021
  • Winning entries will be published on the VETbytes social media pages, by entering the competition you consent to your name being published on their social media pages and website


Latest update: how do you diagnose a colonic torsion?

One of the many VETbytes features is its ‘latest evidence’ feed, which provides a snapshot of the latest evidence in bitesize form, recently added to the emergency and critical care module.

Rapid identification of colonic torsion is imperative to prevent significant ischaemic injuries.

A new study by Czajkowski and Fryer,* describes a rapid, low morbidity test that can be used in cases of suspected colonic torsion in dogs which may help to differentiate this rare condition from generalised ileus or small intestinal volvulus.

To view the full evidence feed and find out how to recognise a colonic torsion in your patients, sign up for a free trial of the VETbytes emergency and critical care module or subscribe for an annual licence for only £99/year!

*Czajkowski, P.S., Fryer, K.J. (2020)
Colonic torsion in 4 Great Danes
Journal of Veterinary Emergency and Critical Care30 (5) 581-586

Ask VETbytes: Post-operative pain relief options for dogs and cats undergoing caesarean section

Ask VETbytes

In our new feature ‘Ask VETbytes’, our team of vets will be answering your questions. This week we were asked “What are the options for post-operative pain relief in dogs and cats undergoing caesarean section?”

This is an area where veterinary evidence is lacking and where our patients don’t always receive adequate analgesia, so we have drawn on both human studies and specialist veterinary consensus to create a practical guide for you and your patients:

  • Despite the paucity of published evidence regarding the safety of analgesic drugs in the pregnant or lactating dog and cat it is important to recognise our responsibility to the welfare of our patients regarding the provision of adequate analgesia10
  • It is estimated that the neonate receives approximately 1–2% of the maternal dose of a drug14
  • A longer acting opioid injection may be administered after all the foetuses have been removed e.g. methadone 0.1–0.2 mg/kg10,41
  • In women, NSAIDs are considered safe and effective analgesia after caesarean section because of their low excretion in breast milk38,40
    The same is considered likely to apply to dogs and cats due to the known physiochemical properties of the drugs13,14
    A single dose administered in the immediate postoperative period is generally advocated10,14
    Consider ongoing administration, as required, for 1-2 days after discharge13
  • Paracetamol is generally considered safe in dogs14 
  • NSAIDs should only be administered if the bitch/queen is normovolaemic and normotensive13
  • Paracetamol should NOT be used in cats14
  • None of these drugs are licensed for lactating bitches or queens, ensure that prior owner consent is obtained for their use

Sign up for a free trial of the VETbytes emergency and critical care module to receive full clinical guides or subscribe for an annual licence for only £99/year!


10. Self, I. (2019)
Anaesthesia for canine caesarean section
Companion Animal; 24 (2) 84-90

13. Robertson, S. (2016)
Anaesthetic management for caesarean sections in dogs and cats
In Practice;38(7) 327-339

14. Mathews, K., Kronen, P.W., Lascelles,D., et al. (2014)
WSAVA Guidelines for Recognition, Assessment and Treatment of Pain
Journal of Small Animal Practice55 (6) E10-68
Full text available

38. Bloor, M. and Paech, M. (2013)
Nonsteroidal anti-inflammatory drugs during pregnancy and the initiation of lactation
Anesthesia and Analgesia;116 (5) 1063-1075

40. Spigset, O., Hägg, S. (2000)
Analgesics and Breast-Feeding: Safety considerations
Paediatric Drugs 2(3), 223–238

41. Romagnoli, N., Barbarossa, A., Cunto, M., et al (2019)
Evaluation of methadone concentrations in bitches and in umbilical cords after epidural or systemic administration for caesarean section: A randomized trial
Veterinary Anaesthesia and Analgesia 46(3), 375-383

Don’t stress: VETbytes offers vital stress relief for emergency vets

Emergency and critical care work can be stressful and demanding, and rising caseloads are contributing to more cases of burnout in the veterinary profession. With the application of evidence-based veterinary medicine, VETbytes offers a stress-relief manifesto.

A new survey conducted by the British Veterinary Association has found that three-quarters of vets are concerned about stress and burnout, with the small animal vet category ‘most concerned’ – a situation compounded by the coronavirus pandemic.

Emergency medicine has the added stress of long work hours, an intense work environment with pressure to efficiently identify clinical needs and manage client expectations. Being able to access the best clinical guidance in emergency situations can be a key factor in managing stress levels and improving patient outcomes.

The emergency and critical care app from VETbytes was created as a clinical support tool for veterinary teams, providing evidence-based veterinary information in concise clinical guides. Vets can now also access the ‘latest updates’ feature to seamlessly stay up to date with the latest findings in ECC.

“VETbytes exists to bring evidence-based medicine to the fore of veterinary general practice,” said Zoë Coker and Bronwen Eastwood, co-founders of VETbytes. “Now is a crucial moment for vets to take action to help reduce stress levels, VETbytes offers a cost-effective and simple way to do this.”

VETbytes provides clear benefits to clinicians such as more efficient case management and reduction of errors and stress, which are especially important during the pandemic.

VETbytes is accessible on mobile, iPad and desktop. The latest evidence added to the ECC app is available to view here.

Podcast Interview: What Vetbytes? Bronwen, Brighton and Belize

Scott Kilpatrick, director (Internal Medicine) at veterinary thought exchange chatted to Bronwen Eastwood, Co-Founder of VETbytes earlier this week for the vtx podcast. Click here to listen to the full interview and hear Bronwen’s amazing career that has taken her from Brighton to Belize and back again!

In the interview, Bronwen explains how she went on to co-found VETbytes, after recognising a void for a resource that provides up-to-date, evidence-based, user-friendly clinical information. Alongside co-founder Zoe Coker, Bronwen co-wrote some of the treatment guides for the VETbytes emergency and critical care app, a subscription-based resource designed to support vets who need to keep up to date and provide an excellent service to their clients and patients. 

Updates feed launched to help vets stay current with evidence-based knowledge

The point-of-care clinical support tool, VETbytes, has added to the veterinary resource by introducing a ‘latest updates’ feed to its first app for emergency and critical care (ECC).

Launched in July in partnership with the BSAVA, VETbytes has enhanced its ability to make relevant research accessible to the end user by implementing a ‘latest updates’ evidence feed to its emergency and critical care (ECC) app.

Vets treating small animals can now access condensed summaries of the most recently published papers relevant to ECC, enabling them to keep up to date with the evidence without having to spend hours reading.

“This new feature will allow users to access real-time updates to the app so they can be assured they are following the most up-to-date clinical guidance,” said Zoë Coker and Bronwen Eastwood, co-founders of VETbytes.

The British Small Animal Veterinary Association (BSAVA), the founding partner of VETbytes, welcomes the development to the ECC app for its members: “The latest addition to the app advances our joint goal with VETbytes, to provide the latest practical, accessible, evidence-based resources for the small animal veterinary community.” said BSAVA President Professor Ian Ramsey.

The VETbytes app is available to BSAVA members with discounted subscription fees and free access is offered to veterinary students.

To view the ‘latest updates’ feed, click here.

The ECC app, available from VETbytes, currently covers more than 100 topics and includes other features such as drug (and CRI) calculators, a quick reference section and links to hundreds of source abstracts, as well as CPD accreditation for reflective learning through usage of the app.

VETbytes is available at the point of care on mobile, iPad or desktop. To start a free trial or subscribe to the VETbytes app, visit

Fecal microbiota transplantation in parvovirus puppies

We’ve noticed an increase in parvovirus cases recently so we thought we’d share a few snippets from the treatment section of our parvovirus page. To see the full condition, subscribe or sign up for a free trial today.

Did you know?

  • In a recent study, parvovirus-infected puppies that received faecal microbiota transplantation (FMT) in addition to standard therapy showed a faster resolution of diarrhoea compared to dogs that only received standard therapy
  • 61% of cases receiving FMT showed resolution of diarrhoea within 48 hours compared to only 5% without


  • 10 g of healthy donor faeces diluted in 10 ml 0.9% NaCl and introduced anally to the proximal rectum via a urinary catheter
  • Maintain in lateral recumbency for 2 minutes with pelvis raised 45% from the surface
  • Perform within 6–12 hrs of admission and repeat q48h until resolution of diarrhoea, or up to five doses

Perira, G.Q., Gomes, L.A., Santos, I.S. et al. (2018)
Fecal microbiota transplantation in puppies with canine parvovirus infection
Journal of Veterinary Internal Medicine; 32 (2) 707-711. Full text available

Don’t forget environmental control

  • Parvovirus can survive in the environment for up to 1 year and is very difficult to kill
  • Clean the area thoroughly first as the presence of organic matter, e.g. faeces or blood, can greatly impact the efficacy of disinfectants
  • Disinfect the environment with sodium hypochlorite (bleach)
    0.75% solution for 1 minute contact time or
    0.37% solution with 15 minute contact time
  • Steam cleaning for surfaces that do not tolerate bleach
  • Careful disposal of faeces

Cavalli, A., Marinaro, M., Desario, C., Corrente, M., Camero, M. and Buonavoglia, C. (2018)
In vitro virucidal activity of sodium hypochlorite against canine parvovirus type 2
Epidemiology and Infection; 146 (15) 2010–2013. Full text available

VETbytes provides the latest evidence-based treatment with its Keep It Simple Summaries (KISS). Quickly access a general overview of how to handle a case, later access the detailed section when you have more time and can reflect upon your learning with our CPD links.

Try VETbytes for 30 days for free, or subscribe for only £9.99/month or £99.00/year (BSAVA members get 33% off). Sign up today.

Xylitol poisoning in dogs in less than a minute with VETbytes

Would you know how to handle a case of xylitol toxicity? Get straight to the point of care with VETbytes’ treatment action plan. Read the ‘Key Points’ checklist in under a minute before the client arrives and know that you are up-to-date and ready for action!

Xylitol poisoning in dogs

  • Ingestion can cause hypoglycaemia, hepatic failure or both
  • Dogs that ingest > 0.05–0.1 g/kg are at risk for developing hypoglycaemia
    This usually occurs 30–60 minutes after ingestion
  • Dogs that ingest > 0.5 g/kg are at risk for developing hepatotoxicosis and acute hepatic failure. This usually occurs 1–3 days after ingestion
  • Can estimate that 1 cup of xylitol contains 190g and 1 piece of gum contains 0.3-1g of xylitol
  • Emesis is indicated unless the animal is showing signs of hypoglycaemia or has ingested 100% xylitol products more than 30 minutes prior to presentation as clinical signs may develop during decontamination, risking aspiration
  • Charcoal is NOT recommended as xylitol is readily absorbed from the gastrointestinal tract and binds poorly to charcoal
  • Administer dextrose to hypoglycaemic patients at a dose of 0.25–0.5 g/kg 50% dextrose i/v over 10 minutes (0.5–1 ml/kg 50% dextrose)
  • Hepatoprotectants are indicated in patients that have ingested hepatotoxic doses, e.g. SAMe, Silybin or N-acetylcysteine. There is however no strong clinical evidence to prove their efficacy
  • Additional treatments may include management of coagulation defects and gastroprotectants although evidence is scarce that hepatic disease is a direct cause of gastroduodenal ulceration and erosion
Don’t be caught out!
  • Dogs may present with acute hepatic failure without having shown initial signs of hypoglycaemia
  • Asymptomatic dogs with known ingestion of xylitol should be hospitalised for at least 72 hours in case of delayed-onset hypoglycaemia which may be seen when gum is ingested, or in case of development of hepatic failure without hypoglycaemia
Prognosis is good for dogs that develop uncomplicated hypoglycaemia but poor to guarded for those that develop hepatic failure.

Try VETbytes for 30 days for free, or subscribe for only £9.99/month or £99.00/year (BSAVA members get 33% off). Sign up today.