Meredith Olsen, MD

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.

This is it. This is the way.

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

Surviving Sepsis 2026 is here & it's even more loony tunes than I was expecting. They're promoting pre-hospital ABX & preemptive broad-spectrum IV antibiotics for intubated patients. This insane fever dream is an antimicrobial stewardship nightmare. Embarrassment for SCCM.

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 🛑

@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 🧐

How can we get to the bottom of this seeming paradox? We need to go deep into the supplement! The key is understanding how clinicians deal with discrepant information. The reduction in mortality was driven by the subset with a high NEWS score and a low procalcitonin. These are the patients that without procalcitonin clinicians could erroneously mistakenly conclude “just have sepsis.” With the extra PCT data point, they were encouraged to reevaluate. This reduced mortality in the patients who ultimately did not have infection. Conclusion: An additional test can help avoid premature closure and get you to reassess! If the data doesn’t fit reconsider! (Sidebar: it’s pretty embarrassing that @TheLancet misspelled “Medium”)

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/

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. ja.ma/4btNGSr

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. 🏥 🩺 🔗 chestphysician.org/print-archive/ #MedTwitter #CriticalCare #AI #MedEd

@DrVish355 Keep er movin 👏👏👏

Just an average medicine resident… after 4 intubations, 3 HD cath insertions and 2 CVPs in one shift

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

Important ECG pattern to recognize, especially at this time of year.

🚨 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 🧵👇

@aclong111 Absolutely love all of these

Lots of ICU time recently. A few thoughts 🧵 1/ There is a discomfort in “doing nothing.” But sometimes the most skillful thing we do is support. Resist the urge to add or subtract just to feel like progress is happening. Patients often need time more than they need novelty.

@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.

All you need to know about antibiotics in 🇺🇸 EDs/wards/ICUs #MedTwitter #idtwitter

Waveform checked, perfusion fine… still SpO₂ low but PaO₂ normal 😐 What is the diagnosis🔍

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

Patient comes into the ICU with shortness of breath, BP 110/94 with HR of 120 and cap refill of 5 seconds and mottling. What do you do? My approach 👇

Weekend digest: name the most likely pathogen - Presents with diarrhea - Abdominal pain - Renal failure Image credit: ASH

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

do you provide scheduled acetaminophen for intubated patients? benefits include mild analgesia, reduced thermal stress to the CNS, fewer nonsensical workups for mild fevers

What do you think?

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

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 👇