Episode 24: Shock

Episode 24: Shock

The VetEmCrit Academy built for ER and ICU vets who want to grow, level up, and learn together: https://academy.vetemcrit.com/join [https://academy.vetemcrit.com/join] In this episode, Dr. Lance Wheeler, DVM, DACVECC tackles one of the most fundamental and time-sensitive syndromes in emergency and critical care - shock, a leading pathway to organ failure and death when it isn't caught early. Drawing from Chapter 6 of Small Animal Critical Care Medicine (3rd edition) by Armelle de Laforcade and Deborah Silverstein, Lance reframes shock not as low blood pressure but as a cellular energy crisis where oxygen delivery fails to meet tissue demand, and walks through a practical, structured framework for recognizing, classifying, and resuscitating shock in real time. He breaks down the four classic circulatory categories (hypovolemic, distributive, cardiogenic, and obstructive) plus hypoxic and metabolic shock, the cellular and compensatory physiology underneath them, and why real patients so often present as mixed shock. He then moves into bedside recognition and management, including his "3 strikes" diagnostic approach, perfusion parameters and resuscitation targets, lactate and lactate clearance, shock index, the rectal-interdigital temperature gradient, venous oxygen saturation, fluid choice and shock-dose framework with the critical 25%-at-30-minutes caveat, hypotensive resuscitation, and when to reach for vasopressors and inotropes. Along the way, he integrates the latest veterinary evidence, including 2013-2025 studies on canine and feline septic shock phenotypes, shock index in hemorrhage, head trauma, and cats, caudal vena cava to aorta ratio, and splenic Doppler resistance index, and closes with a high-yield rapid-fire board review covering every key number worth memorizing. If you enjoy this episode and want the full experience, weekly deep-dives, interactive simulators, and clinical algorithms you can use on shift, come join us inside the VetEmCrit Academy.

Episode 23: Status epilepticus and cluster seizures

The VetEmCrit Academy built for ER and ICU vets who want to grow, level up, and learn together: https://academy.vetemcrit.com/join [https://academy.vetemcrit.com/join] In this episode, Dr. Igor Yankin, DVM, DACVECC tackles one of the highest-stakes neurologic emergencies on the floor - status epilepticus and cluster seizures in dogs and cats, where every minute of ongoing seizure activity drives accumulating neuronal injury. Built entirely around the 2024 ACVIM consensus statement on seizure management published in the Journal of Veterinary Internal Medicine - the most comprehensive evidence-based guideline we have for seizure emergencies - Igor starts by making the definitions crystal clear, because the treatment algorithm hinges on them. He then walks through a practical, structured escalation framework with real doses and timing. If you enjoy this episode and want the full experience, weekly deep-dives, interactive simulators, and clinical algorithms you can use on shift, come join us inside the VetEmCrit Academy.

Episode 22: Post-Cardiac Arrest Care in Dogs and Cats

The VetEmCrit Academy built for ER and ICU vets who want to grow, level up, and learn together: https://academy.vetemcrit.com/join [https://academy.vetemcrit.com/join] In this episode, Dr. Lance Wheeler, DVM, DACVECC tackles what happens after the pulse comes back - post-cardiac arrest care, one of the most complex and high-stakes phases of critical illness. Drawing from Chapter 5 of Small Animal Critical Care Medicine (3rd edition) by Manuel Boller and Daniel Fletcher, and weaving in the key updates from the 2024 RECOVER guidelines, Lance walks through a practical, structured framework for managing patients in the first minutes, hours, and days after ROSC: preventing early rearrest, recognizing the four components of post-cardiac arrest syndrome (systemic ischemia-reperfusion injury, brain injury, myocardial dysfunction, and the persistent precipitating disease), and building a physiologic environment that lets the brain and heart recover. He then moves through the practical bedside management such as controlled reoxygenation to normoxemia rather than hyperoxemia, normocapnic ventilation targets, hemodynamic goals and the fluid/norepinephrine/dobutamine approach to hypotension, glucose and adrenal considerations, targeted temperature management and slow rewarming, seizure and cerebral edema management, and the reversible nature of myocardial stunning. Along the way, he integrates the latest veterinary evidence, including 2021-2025 studies on functional outcomes after discharge, ROSC and survival predictors, post-ROSC blood-gas and electrolyte variables, global hypoxic-ischemic brain injury, neuroprognostication windows, and reversible myocardial dysfunction, and closes with a high-yield rapid-fire board review covering every key number worth memorizing. If you enjoy this episode and want the full experience, weekly deep-dives, interactive simulators, and clinical algorithms you can use on shift, come join us inside the VetEmCrit Academy.

Episode 21: Cardiopulmonary resuscitation in dogs and cats

The VetEmCrit Academy built for ER and ICU vets who want to grow, level up, and learn together: https://academy.vetemcrit.com/join [https://academy.vetemcrit.com/join] In this episode, Dr. Lance Wheeler, DVM, DACVECC tackles one of the highest-stakes situations in emergency and critical care - cardiopulmonary arrest and resuscitation. Drawing from Chapter 4 of Small Animal Critical Care Medicine (3rd edition) by Daniel Fletcher and Manuel Boller, and weaving in the key updates from the 2024 RECOVER CPR guidelines, Lance walks through a practical, structured framework for managing arrest in real time: rapid recognition (the "shake and shout"), the CAB sequence, high-quality BLS, the physiology of coronary perfusion pressure, and how chest conformation changes compression strategy. He then moves into advanced life support such as ECG and capnography monitoring, epinephrine and vasopressin dosing, atropine, defibrillation energy, the lidocaine/amiodarone/esmolol ladder for refractory shockable rhythms, reversal agents, fluids, sodium bicarbonate, and when to consider open-chest CPR. Along the way, he integrates the latest veterinary evidence, including 2023–2025 studies on ROSC predictors, blood-gas variables, conformation-based outcomes, shockable rhythm prevalence, and CPR skill retention, and closes with a high-yield rapid-fire board review covering every key number worth memorizing. If you enjoy this episode and want the full experience, weekly deep-dives, interactive simulators, and clinical algorithms you can use on shift, come join us inside the VetEmCrit Academy.

Episode 20: Journal Club (NG tubes, pericardiocentesis, platelet transfusion)

The VetEmCrit Academy built for ER vets who want to grow, level up, and learn together: https://academy.vetemcrit.com/join [https://academy.vetemcrit.com/join] This episode reviews three papers: radiographic guidelines for confirming NG/NE tube placement in dogs and cats, the effect of operator experience on pericardiocentesis adverse events, and a retrospective evaluation of lyophilized platelet use in dogs — with practical clinical takeaways for each.