Meredith Olsen, MD

CCM. Love the RV, a good shock exit strategy and MedEd.

[Nick Mark MD @nickmmark]

One of my favorite aviation phrases:
“Superior pilots use their superior judgement to avoid having to demonstrate their superior skills.”

It’s true for any proceduralist btw.

[Meredith Olsen, MD @MereLOlsen]

This is it. This is the way.

[Dr. Chacón-Lozsán F .'. @franciscojlk]

I just read this outstanding review by Prof. Michael Pinsky:

👉 “The Effective Management of Shock: From Physiology to Guidelines to Personalized Medicine”

🧠 Key paradigm shift:

👉 Shock is not about numbers
👉 It is about tissue perfusion and cellular metabolism

⚠️ Three brutal truths (often ignored in daily practice):

1️⃣ Once organ injury occurs → we cannot reverse it
→ We can only limit further damage

2️⃣ Monitoring alone does not improve outcomes
→ Only actions linked to effective therapies matter

3️⃣ Guidelines ≠ patient care
→ The clinician’s physiologic reasoning remains central

📊 Why many “standard” approaches failed:

Targeting DO₂ “supranormal” levels → ↑ mortality

EGDT bundles → not superior to good early care

Fixed 30 mL/kg fluids → harmful in non-responders

👉 Lesson:
One-size-fits-all resuscitation is physiologically wrong

🫀 Modern hemodynamic thinking:

✔️ Fluid responsiveness matters (PPV, SVV, PLR)
✔️ MAP alone is not enough
✔️ Focus on:

Tissue perfusion pressure

Critical closing pressure (Pcc)

“Vascular waterfall” concept

👉 Increasing MAP ≠ improving microcirculation

🔥 Game-changing concept:

👉 Shock = failure of microcirculatory flow regulation

Even with:
Normal CO
Normal MAP

➡️ Tissue hypoxia may persist

🧬 The real goal of resuscitation:

❌ Normalize numbers
✅ Restore effective tissue perfusion early
✅ Avoid iatrogenic harm

💡 Where we are going:

Capillary refill time (CRT)-guided resuscitation

Personalized MAP targets

Dynamic physiology-based decisions

AI-driven precision resuscitation

📌 Take-home message:

👉 The future of shock management is NOT:

More fluids

More drugs

More devices

👉 It is: Better understanding of physiology + individualized care

🧠 And maybe the most important sentence in the paper:

👉 “The thoughtful bedside clinician remains the gold standard.”

#CriticalCare #Shock #Hemodynamics #ICU #Sepsis #PersonalizedMedicine #Resuscitation #Pinsky

[Meredith Olsen, MD @MereLOlsen]

@PulmCrit lol I love that they put suggest in quotation marks. Those don’t mean what I think they’re trying to emphasize.

[Meredith Olsen, MD @MereLOlsen]

I actually like this. PCT, like everything else, is a tool in the toolbox. I have used it both ways- check it up front with the intention to use it to deescalate abx in a few days, but if negative up front then it’s time to take a diagnostic pause 🛑

[Nick Mark MD @nickmmark]

The results of the PRONTO RCT of procalcitonin in people with suspected sepsis are absolutely fascinating.

Mortality was significantly lower in the procalcitonin-guided care group: 13.6% (372/2738) vs 16.6% (450/2715) (p=0.0009) but there was no difference in antibiotic initiation, narrowing, or days of therapy!

So apparently procalcitonin saves lives even if it doesn’t change antibiotic prescribing? 🤔

1/

[Meredith Olsen, MD @MereLOlsen]

@nickmmark I actually like this. PCT, like everything else, is a tool in the toolbox. I honestly have used it both ways- check it up front with the intention to use it to deescalate abx in a few days, but if negative up front then it’s time to reevaluate ddx assumptions 🧐

[JAMA Network Open @JAMANetworkOpen]

Peripheral vasopressor administration in critically ill adults was associated with a low incidence of adverse events—major events were rare using short peripheral intravenous catheters, and use avoided central venous catheter placement in 60% of cases.

https://t.co/cInCBzu8x8

[Meredith Olsen, MD @MereLOlsen]

Ready or not, AI is here. 🤖 So proud to have co-authored this piece with the brilliant Dr. Ashna Manhas in @CHESTPhysician!
Predictive models and LLMs are moving from the "black box" to the bedside. 🏥 🩺
🔗 https://t.co/gPd9WyayFG
#MedTwitter #CriticalCare #AI #MedEd

[Meredith Olsen, MD @MereLOlsen]

@DrVish355 Keep er movin 👏👏👏

[Meredith Olsen, MD @MereLOlsen]

@nickmmark JUST has this yesterday. Core temp initially 27C 🥶

[Muhammad Qudrat Ullah, MD @QudratUllahRana]

🚨 The 2026 AHA/ACC PE guidelines changed how we think about pulmonary embolism.
Not just new treatments — a new clinical framework.
Say goodbye to “massive vs submassive.”
Meet A–E PE Clinical Categories 🧵👇

[Meredith Olsen, MD @MereLOlsen]

@aclong111 Absolutely love all of these

[Meredith Olsen, MD @MereLOlsen]

@IM_Crit_ Come on. Where are cefepime, mero, valacyclovir, mica and doxy in this picture!? I’m at least a seven-trick pony when it comes to Abx.

[Meredith Olsen, MD @MereLOlsen]

@EM_RESUS

[Meredith Olsen, MD @MereLOlsen]

@JasmineNephro

[Meredith Olsen, MD @MereLOlsen]

@ross_prager Hypotension in this patient is too late. They’re on the express train to dead unless you intervene.

[Meredith Olsen, MD @MereLOlsen]

@MayoClinicINFD

[Meredith Olsen, MD @MereLOlsen]

@PulmCrit Neuro patients? Yes. All comers? No.

[Meredith Olsen, MD @MereLOlsen]

What do you think?

[Meredith Olsen, MD @MereLOlsen]

I just saw a headline that said “Doctors Don’t Owe Society Anything”. I am affected by the same public skepticism and loss of trust in the medical establishment as every other provider, but I disagree 👇

[Meredith Olsen, MD @MereLOlsen]

What we don’t owe society:
- so much of ourselves that we lose our health, sanity, and souls