September is Sepsis Awareness Month – Spot the signs to get ahead of sepsis

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Sepsis is the body’s extreme reaction to any infection. It is a medical emergency that affects at least 1.7 million people each year in the United States and kills nearly 270,000.  Early detection offers the best chance for survival and can limit life-long complications. Otherwise, it can lead to tissue damage, organ failure, and even death. This month is Sepsis Awareness Month, and it’s a good time to get ahead of sepsis by learning the risks and how to avoid them.

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Signs of Sepsis

What are the signs of sepsis you should never ignore?

If you, a loved one, or in the case of medical professionals their patient, feels “severely sick”, doesn’t appear to be themselves and shows any of the following symptoms, sepsis should be suspected:

weakness
loss of appetite
fever and chills
thirst
difficult or rapid breathing
rapid heart rate
low blood pressure
low urine output

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Treatment for Sepsis should not be delayed

In almost every case of sepsis, patients need to be hospitalized, treated with appropriate intravenous antibiotics (usually broad-spectrum), and given therapy to support any organ dysfunction. Sepsis can quickly cause organ damage and death; therapy should not be delayed as statistics suggest as high as a 7% mortality increase per hour if antibiotics are delayed in severe sepsis. Most cases of sepsis are treated in an intensive care unit (ICU) of the hospital by critical care medicine specialists, infectious disease specialists, and others as needed.

Appropriate antibiotics to treat sepsis are combinations of two or three antibiotics given at the same time; most combinations usually include vancomycin to treat many MRSA and other antibiotic-resistant (drug-resistant) infections. Some of the commonly used antibiotics used are

ceftriaxone (Rocephin),
meropenem (Merrem),
ceftazidime (Fortaz),
cefotaxime (Claforan),
cefepime (Maxipime),
piperacillin and tazobactam (Zosyn),
ampicillin and sulbactam (Unasyn),
imipenem/cilastatin (Primaxin),
levofloxacin (Levaquin), and
clindamycin (Cleocin).

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However, once the infecting organism is isolated, labs can determine which antibiotics are most effective against the organisms, and those antibiotics should be used to treat the patient. In addition to antibiotics, two other major therapeutic interventions, organ-system support and surgery, may be needed. First, if an organ system needs support, the intensive care unit can often provide it (for example, intubation [mechanical ventilation] to support lung function or dialysis to support kidney function) or a central venous catheter and fluid replacement with intravenous fluids and/or antihypotensive medication to raise blood pressure (norepinephrine [Levophed] or phenylephrine [Neo-Synephrine] administered by IV). Secondly, surgery may be needed to drain or remove the source of infection. Amputation of extremities has been done to save some patients’ lives.

Sepsis Six

The Sepsis Six is the name given to a bundle of medical therapies designed to reduce mortality in patients with sepsis.

2011, The UK Sepsis Trust published evidence that use of the Sepsis Six was linked to a 50% reduction in mortality, a decreased length of stay in hospital, and fewer intensive care days.[3] – findings that have since been replicated around the world.

The Sepsis Six consists of three diagnostic and three therapeutic steps – all to be delivered within one hour of the initial diagnosis of sepsis:

Titrate oxygen to a saturation target of 94%
Take blood cultures and consider source control
Administer empiric intravenous antibiotics
Measure serial serum lactates
Start intravenous fluid resuscitation
Commence accurate urine output measurement.

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Sepsis overview

Sepsis symptoms in children under five

Go straight to A&E or call 999 if your child has any of these symptoms:
looks mottled, bluish or pale
is very lethargic or difficult to wake feels abnormally cold to touch
is breathing very fast
has a rash that does not fade when you press it
has a fit or convulsion
Get medical advice urgently from NHS 111
If your child has any of the symptoms listed below, is getting worse or is sicker than you’d expect (even if their temperature falls), trust your instincts and seek medical advice urgently from NHS 111.

Temperature

temperature over 38C in babies under three months
temperature over 39C in babies aged three to six months
any high temperature in a child who cannot be encouraged to show interest in anything
low temperature (below 36C – check three times in a 10-minute period)

Breathing

finding it much harder to breathe than normal – looks like hard work
making “grunting” noises with every breath
can’t say more than a few words at once (for older children who normally talk)
breathing that obviously “pauses”
Toilet/nappies
not had a wee or wet nappy for 12 hours

Eating and drinking

new baby under one month old with no interest in feeding
not drinking for more than eight hours (when awake)
bile-stained (green), bloody or black vomit/sick

Activity and body

soft spot on a baby’s head is bulging
eyes look “sunken”
child cannot be encouraged to show interest in anything
baby is floppy
weak, “whining” or continuous crying in a younger child
older child who’s confused
not responding or very irritable
stiff neck, especially when trying to look up and down
If your child has any of these symptoms, is getting worse or is sicker than you’d expect (even if their temperature falls), trust your instincts and seek medical advice urgently from NHS 111.

Sepsis symptoms in older children and adults
Early symptoms of sepsis may include:

a high temperature (fever) or low body temperature
chills and shivering
a fast heartbeat
fast breathing
In some cases, symptoms of more severe sepsis or septic shock (when your blood pressure drops to a dangerously low level) develop soon after.

These can include:

feeling dizzy or faint
a change in mental state – such as confusion or disorientation
diarrhoea
nausea and vomiting
slurred speech
severe muscle pain
severe breathlessness
less urine production than normal – for example, not urinating for a day
cold, clammy and pale or mottled skin
loss of consciousness
When to get medical help
Seek urgent medical advice from your GP if you’ve recently had an infection or injury and you have possible signs of sepsis, and ask ‘is this sepsis?’. If your GP practice is closed, phone the 111 service.

If sepsis is suspected, you’ll usually be referred to hospital for further diagnosis and treatment.

Severe sepsis and septic shock are medical emergencies. If you think you or someone in your care has one of these conditions, go straight to A&E or call 999.

Tests to diagnose sepsis
Sepsis is often diagnosed based on simple measurements such as your temperature, heart rate and breathing rate. You may need to give a blood test.

Other tests can help determine the type of infection, where it’s located and which body functions have been affected. These include:

urine or stool samples
a wound culture – where a small sample of tissue, skin or fluid is taken from the affected area for testing
respiratory secretion testing – taking a sample of saliva, phlegm or mucus
blood pressure tests
imaging studies – such as an X-ray, ultrasound scan or computerised tomography (CT) scan

What Causes Septicemia

What causes septicemia?

Septicemia is caused by an infection in another part of your body. This infection is typically severe. Many types of bacteria can lead to septicemia. The exact source of the infection often can’t be determined. The most common infections that lead to septicemia are:

urinary tract infections
lung infections, such as pneumonia
kidney infections
infections in the abdominal area
Bacteria from these infections enter the bloodstream and multiply rapidly, causing immediate symptoms.

People who are already in the hospital for something else, such as a surgery, are at a higher risk of developing septicemia. Secondary infections can occur while in the hospital. These infections are often more dangerous because the bacteria may already be resistant to antibiotics. You’re also at a higher risk of developing septicemia if you:

have severe wounds or burns
are very young or very old
have a compromised immune system, which can occur from diseases such as HIV or leukemia
have a urinary or intravenous catheter
are on mechanical ventilation
are receiving medical treatments that weaken your immune system, such as chemotherapy or steroid injections

Symptoms of Sepsis

 

Stage 1:
Uncomplicated sepsis caused by infections . Initial response with SIRS, that is manifested by two or more of the following conditions:
Temperature >38.3°C or <36.0°C
Heart rate >90bpm
Respiratory rate >20 breaths/min
White cell count <4 or >12g/L
New altered mental state
Blood glucose >7.7mmol/L (not diabetic)

Stage 2:
Severe sepsis occurs when the body’s response to infection has started to interfere with the function of vital organs. The organs affected are heart, kidneys, lungs or liver. Severe sepsis is associated with organ dysfunction, hypoperfusion or hypotension. Severe sepsis is manisfested by the following conditions:
Central nervous system: Acutely altered mental status
Cardiovascular system: Systolic <90 or mean <65mmHg
Respiration: SpO2 >90% only with new/more oxygen
Renal: Creatinine >177μmol/L or urinary output <0.5ml/kg/hr for 2 hrs
Hepatic: Bilirubin >34μmol/L
Bone marrow: Platelets <100
Hypoperfusion: Lactate >2mmol/L
Coagulation: international normalized ratio >1.5 or partial thromboplastin time >60 seconds

Stage 3:
Septic Shock: several organs stop functioning sequentially or simultaneously, and cardio-circulatory failure leads to a sudden drop in blood pressure. Sepsis-induced hypotension despite adequate fluid resuscitation, along with the presence of perfusion abnormalities that may include – but are not limited to – lactic acidosis, oliguria or an acute alteration in mental status. Patients receiving inotropic or vasopressor agents may not be hypotensive at the time that perfusion abnormalities are measured.

sepsis

Suspected sepsis, known as the ‘silent killer’, should be treated as a serious emergency, similarly to someone having a heart attack, says England’s health watchdog, NICE. We look into what causes sepsis as well as the signs, symptoms and treatment of this potentially fatal infection.

New guidelines from NICE (The National Institute of Health and Care Excellence) are advising doctors to look out for sepsis when treating people with infections.

What is sepsis?

Sepsis, also referred to as blood poisoning or septicaemia, is a potentially life-threatening condition, triggered by an infection or injury.

It affects 150,000 people every year in the UK, including 10,000 children, and leads to around 44,000 deaths. However, it is now thought that this figure could be reduced by between roughly 5,000 to 13,000, each year.

Initial symptoms of sepsis can often be vague, and can be hard to recognise apart from other conditions, which is why it is often referred to as the ‘silent killer’.

The health watchdog is now saying that GPs, paramedics and hospital staff should always ask themselves: ‘Could this be sepsis’, straight away when treating anyone who is unwell with an infection.

This is in the same way that a doctor’s first consideration for someone with chest pains is: ‘Could this be a heart attack?’

It’s important for mums to make sure their child is checked for sepsis as early as possible, if they have an infection or injury.

Why is sepsis so dangerous?

Sepsis is a potentially life-threatening condition, triggered by an infection or injury.

The body’s immune system goes into overdrive, setting off a series of reactions, including widespread inflammation, swelling and blood clotting.

This can lead to a significant decrease in blood pressure, which can mean the blood supply to vital organs such as the brain, heart and kidneys, is reduced.

If not treated quickly, sepsis can eventually lead to multiple organ failure and death.

Signs and symptoms of sepsis

Early symptoms of sepsis usually develop quickly and can include:

a high temperature (fever)
chills and shivering
a fast heartbeat
fast breathing
In some cases, symptoms of more severe sepsis or septic shock (when your blood pressure drops to a dangerously low level) develop soon after. These can include:

feeling dizzy or faint
confusion or disorientation
nausea and vomiting
diarrhoea
cold, clammy and pale or mottled skin
slurred speech
severe muscle pain
severe breathlessness
less urine production than normal (for example, not weeing for a day)
cold hands and feet