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 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.