Sepsis: When Infections Turns Deadly, Pt 4 (4:35)
Infections can be bad enough, but if one turns septic it becomes a medical emergency. That was the conclusion the Centers for Disease Control and Prevention (CDC) reinforced in August 2016 after it examined the medical records of 246 adults and 79 children in four New York hospitals. And while healthcare providers have been doing a better job of recognizing the signs of sepsis, the CDC has since made a push to get more information about sepsis into the hands of healthcare providers and patients.
“It comes down to training,” says Claudio Fernandez, DO, an emergency medicine doctor and internist with Westside Regional Medical Center in Plantation, Florida. “I’m an ER doctor so I see sepsis a lot. Different fields of medicine and outpatient doctors might not be exposed as much to sepsis.”
What is Sepsis?
When the body encounters a foreign substance like a bacteria or virus, it sics the immune system on it. The immune system normally responds by creating enough inflammation to neutralize the foreign substance. But with sepsis, the immune system produces so much inflammation that it can lead to organ damage and failure.
Diagnosing sepsis is complicated, since symptoms can be mistaken for another condition. Healthcare providers use a combination of the person’s medical history, blood work, and observation, Dr. Fernandez says. Medical history is important because it can help reveal how the infection started. More than one-third — 35 percent — of the sepsis cases in the CDC study started as pneumonia. A quarter developed from urinary tract infections, while 11 percent each came from gut infections and skin infections. A healthcare provider might look more closely at someone who recently had one of those conditions, or order extra blood work.
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Healthcare providers in the past used the SIRS checklist, which stands for systemic inflammatory response syndrome, to help diagnose sepsis, but it’s being phased out. Many still use the SIRS checklist, however. “I’m looking for the vitals,” says Fernandez. “Is the patient feverish? How’s the breathing, is it fast?”
Other SIRS criteria include a rapid heart rate and a high white blood cell count, obtained from blood work. The new criteria looks for low blood pressure, rapid breathing, and altered mentation, which could be confusion, lethargy, disorientation, strange behavior, or even hallucination. Two of the three, along with a suspected infection source like pneumonia, is usually enough to diagnose sepsis.
Blood work can also show high levels of lactate, which usually indicates severe illness. Other, more general sepsis symptoms include:
- Shivering, feeling cold, or low body temperature
- Extreme pain
- Clammy or sweaty skin
A Medical Emergency
The very young, the very old, and people with weakened immune systems are the most vulnerable to sepsis, but anyone can get it. IV fluids and antibiotics are the mainstays of sepsis treatment. Treatments like dialysis may be necessary to keep failing organs working. Since sepsis develops quickly and in stages, it’s extremely important to recognize the signs and get treated as soon as possible.
“The earlier you recognize sepsis, the earlier you can start treating it,” says Fernandez. Every hour that goes by without antibiotics means a 7.6 percent increase in mortality rate for septic shock, a severe form of sepsis. “The earlier the better,” says Fernandez. “It can make a big difference in a patient.”