Advertise on podcast: VetEmCrit: The Veterinary Emergency & Critical Care Podcast

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 of Wheeler the Healer: Small Animal Emergency and Critical Care, we break down predictive scoring systems in veterinary ECC and how to use them without letting them replace clinical judgment. We review major systems including ATT, mGCS, APPLE, qSOFA, TASH, DOGiBAT, HeLP, and T-STAT while discussing what these tools actually measure, what outcomes they predict, and why many models perform worse during external validation in real-world patients. Along the way, we cover key board-relevant concepts including AUROC, calibration, confounding, illness-severity bias, occult hemorrhagic shock, and why population-level prediction does not equal certainty for the individual patient in front of you. The episode emphasizes a central ECC principle: predictive scores can support bedside reasoning, but the patient—not the calculator—is still the gold standard. 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.

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 of Wheeler the Healer: Small Animal Emergency and Critical Care, Lance Wheeler, DVM, DACVECC explores patient suffering in the veterinary ICU and reframes it as both an ethical and physiologic problem rather than simply an emotional one. Inspired primarily by Chapter 12 of Small Animal Critical Care Medicine, 3rd edition, the episode examines primal alert signals like dyspnea, pain, nausea, thirst, hunger, anxiety, and sleep deprivation, emphasizing that critically ill animals often experience many of these simultaneously. The discussion reviews why air hunger may be more distressing than pain, how untreated nausea and sleep disruption can worsen recovery, and how ICU noise, repeated handling, and hospitalization stress may contribute to physiologic instability. Integrating recent literature on dyspnea-targeted therapy, anxiolytics, feline environmental modification, wireless monitoring, and individualized nursing care, the episode focuses on practical strategies to reduce suffering in real time. Ultimately, the episode argues that comfort-focused interventions are not separate from critical care—they are a fundamental part of stabilizing the critically ill patient. 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.

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. Igor Yankin, DACVECC introduces the new Arterial Blood Gas Analyzer inside the VetEmCrit Academy - a tool built around the question every dyspneic patient forces on you at the cage side: are the lungs failing, is this patient simply not ventilating, or both? And Why? Igor walks through the reasoning the tool automates: the alveolar gas equation, the A–a gradient and where its published normals actually stop, the 120 rule, the P/F and S/F ratios, the oxygenation index and the oxygen saturation index, arterial oxygen content and the patient-specific cyanosis threshold, the full oxygen cascade from ambient air down to arterial blood, and the ARDSVet 2025 screen. He then moves into the practical half: the FiO₂ device estimator that works out inspired oxygen from delivery method and flow rate and names the study each estimate came from, the differential table that works through every mechanism of hypoxemia in turn and states plainly what a blood gas cannot tell you, the button that drops the whole analysis into the medical record as plain text with its caveats attached, printing, serial trending, and the 19 built-in demo cases.

The VetEmCrit Academy built for ER and ICU vets who want to grow, level up, and learn together: https://academy.vetemcrit.com/join This episode explains interstitial edema as altered tissue fluid traffic rather than simply “too much fluid.” It reviews classic and revised Starling physiology, emphasizing the endothelial glycocalyx, sub-glycocalyx space, lymphatic drainage, and why fluid usually returns through lymphatics rather than routine venous-end reabsorption. The episode breaks down the major edemagenic mechanisms—venous hypertension, hypoproteinemia, increased permeability, impaired lymph flow, and increased negativity of interstitial pressure—and connects them to ICU decisions around fluids, albumin, pulmonary edema, effusions, and reassessment. It also highlights key clinical evidence, including fluid risk in pulmonary disease, limitations of albumin and synthetic colloids, canine albumin and cryopoor plasma studies, gallbladder wall thickening in hypoalbuminemic dogs, and Simplified Light’s criteria for feline pleural effusion classification. 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.

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 the number we take on every single patient and misread more often than any other - body temperature, and the fork in the road between true fever and nonfebrile hyperthermia. Drawing from Chapter 10 of Small Animal Critical Care Medicine (3rd edition) by James Miller, Lance separates a regulated, cytokine- and prostaglandin-mediated change in the hypothalamic set point from a straightforward failure of heat balance, and walks through a practical, structured framework for reading temperature in real time: thermoregulation in the preoptic anterior hypothalamus and the heat gain, conservation, and loss mechanisms behind it, exogenous versus endogenous pyrogens and the interleukin-1, interleukin-6, and tumor necrosis factor alpha pathway to prostaglandin E2, why fever can be protective in infection and harmful in brain injury, the roughly 7 percent rise in water and caloric requirement for every 1°F above normal, and the thresholds worth memorizing - above 102.5°F is elevated, above 106°F demands immediate total body cooling, and 107°F is the organ injury danger zone. He then moves into the causes and the bedside management, including heat stroke and the closed car that exceeds 120°F in under 20 minutes on a 75°F day, nucleated red blood cells as a prognostic marker, exertional hyperthermia and hyperpyrexic syndrome, eclampsia and seizures as heat sources you have to switch off rather than cool around, malignant hyperthermia and dantrolene, opioid-associated hyperthermia in cats, why lukewarm beats ice water and why you stop active cooling at 103°F, and why antibiotics are not antipyretics. Along the way, he integrates the latest veterinary evidence, including 2020-2026 studies on juvenile canine pyrexia, triage temperature as a predictor of outcome in cats, buprenorphine and postoperative hyperthermia, cooling strategies in working dogs, nose and axillary temperature accuracy, feline vector-borne disease, and heat-related mortality, 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.

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 the vascular structure we damage constantly and almost never measure - the endothelial surface layer, and why a patient's blood pressure can look better while the microcirculation is still a disaster. Drawing from Chapter 9 of Small Animal Critical Care Medicine (3rd edition) by Lisa Smart and Deborah Silverstein, Lance builds the anatomy from the ground up using a forest analogy, with syndecans and glypican-1 as the trunks, heparan sulfate and chondroitin and dermatan sulfate as the branches, hyaluronan as the undergrowth, and the immobile plasma layer as fog trapped inside the canopy, then connects that structure to the revised Starling principle, the protein-poor subglycocalyx space, and why sustained capillary reabsorption does not happen the way most of us were taught. He then moves into how the layer gets shed and what that costs at the bedside, including trauma, inflammation, hyperglycemia, hemodilution and hypervolemia as the major hits, thrombin and plasmin cleaving syndecan ectodomains, lipopolysaccharide accelerating shedding, glycocalyx fragments acting as DAMPs that amplify the very inflammation that caused them, perfused boundary region as an inverse measure of glycocalyx thickness, and loss of hemodynamic coherence when the monitor improves but the tissue does not. Along the way, he integrates the latest veterinary evidence, including 2021-2026 studies on perioperative crystalloid rate and circulating hyaluronan, fluid challenges in healthy anesthetized cats, shelf-stable blood products in a canine hemorrhagic shock model, fresh-frozen plasma in critically ill dogs, trauma biomarker dynamics over 24 hours, feline hemotropic mycoplasmosis, and cardiopulmonary bypass, 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.

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 the therapy we reach for most reflexively and titrate least carefully - oxygen, and what happens when the dose we give exceeds the dose the patient actually needs. Drawing from Chapter 8 of Small Animal Critical Care Medicine (3rd edition) by Duana McBride, and weaving in the 2023 New England Journal of Medicine review "Oxygen Therapy Part 2 - Indications and Toxicity" by Wemple et al., Lance reframes oxygen as a dose-dependent drug rather than a benign intervention and walks through a practical, structured framework for recognizing and avoiding oxidative harm: how 90 to 95 percent of oxygen is safely reduced to water while roughly 5 percent forms reactive oxygen and nitrogen species, the superoxide to hydrogen peroxide cascade and the Fenton, myeloperoxidase, and peroxynitrite pathways branching off it, how lipid peroxidation and DAMP release turn oxidative injury into a self-amplifying inflammatory cycle, and why the xanthine oxidoreductase system fires within 10 to 30 seconds of reperfusion. He then moves into the organ-by-organ consequences and the numbers that actually change bedside decisions, including absorption atelectasis and surfactant impairment in the lung, hyperoxic vasoconstriction and falling cardiac output, cerebral blood flow and traumatic brain injury, ventilated targets of SpO2 88 to 92 percent and PaO2 55 to 80 mm Hg, the FiO2 0.5 anchor below which clinical pulmonary oxygen toxicity is generally absent, hyperbaric oxygen therapy at 1.5 to 3.0 atmospheres absolute and its CNS toxicity risk, and where antioxidants genuinely fit. Along the way, he integrates the veterinary evidence, including 2021-2025 studies on hyperbaric oxygen adverse events across 2,792 treatment sessions, dietary antioxidants in dogs and cats, and N-acetylcysteine in Babesia gibsoni infection, 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.

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 the syndrome that turns a sick patient into a dying one - systemic inflammation, sepsis, and multiple organ dysfunction, where the host's own response does as much damage as the infection itself. Drawing from Chapter 7 of Small Animal Critical Care Medicine (3rd edition) by Kaitlyn Rank and Bernie Hansen, and weaving in the 2024 JVECC position statement "Defining sepsis in small animals" by Cortellini et al., Lance traces how the definitions evolved from the 1991 Sepsis-1 consensus through PIRO to Sepsis-3, and builds a practical, structured framework for recognizing these patients in real time: the original definitions of infection, bacteremia, sepsis, severe sepsis, septic shock and MODS, the human 2-of-4 SIRS criteria and their canine and feline adaptations, why cats require 3 of 4 while dogs require 2 of 4, why SIRS is sensitive but badly nonspecific, and why organ dysfunction rather than inflammation is the modern center of gravity. He then moves into the bedside half, including the perfusion exam, hunting the infectious source, when to culture and when not to wait, rational antimicrobial selection, source control, and how to use SOFA, qSOFA, and APPLE scoring without letting a number replace clinical judgment. Along the way, he integrates the veterinary evidence from Hauptman and Brady through 2020-2025 work on parvovirus as a sepsis model, SIRS criteria in the emergency department, organ dysfunction and outcome in septic peritonitis, SOFA trajectory in ICU dogs, qSOFA validation, APPLEfull and APPLEfast cutoffs, and antimicrobial timing versus source control, 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.

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.

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. 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.

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 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.

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 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.

The VetEmCrit Academy built for ER vets who want to grow, level up, and learn together: 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.

The VetEmCrit Academy built for ER vets who want to grow, level up, and learn together: https://academy.vetemcrit.com/join In this episode, Dr. Lance Wheeler, DVM, DACVECC continues building on the previous episodes' triage and serial-assessment foundations and shifts the focus to one of the most consequential physiologic systems in emergency and critical care — hemostasis. Drawing from Chapter 3 of Small Animal Critical Care Medicine (3rd edition) by Ronald Lee, Lance walks through hemostasis in a practical, stepwise way: the three stages of platelet activation (initiation, extension, stabilization), the cell-based model of coagulation (initiation, amplification, propagation, termination), the vitamin K–dependent factors, the tenase and prothrombinase complexes, fibrinolysis and its endogenous inhibitors, and the increasingly important concept of immunothrombosis and neutrophil extracellular traps in sepsis. Along the way, he weaves in the most current veterinary evidence — including 2024–2025 studies on trauma-associated coagulopathy, hyperfibrinolysis in cats, the TXA hemorrhagic shock trial in dogs, and the link between sepsis, fibrinolysis inhibitors, and NETs — 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.

The VetEmCrit Academy built for ER vets who want to grow, level up, and learn together: https://academy.vetemcrit.com/join In this episode, Dr. Lance Wheeler, DVM, DACVECC builds on the previous episode's triage discussion and shifts the focus to one of the most underappreciated skills in modern emergency and critical care — the daily physical examination of the critically ill patient. Drawing from Chapter 2 of Small Animal Critical Care Medicine (3rd edition) by Timothy Hackett, Lance makes the case that no monitor, point-of-care ultrasound, or laboratory analyzer can replace a structured, intentional bedside exam — especially when it comes to assessing perfusion, hydration, and overall trajectory in real time. 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.