Understanding Sepsis

By Leigh Vinocur, MD, FACEP Board-certified Emergency Physician, Adjunct Assistant Professor LSU Health-Shreveport

Posted on | By Leigh Vinocur, MD, FACEP | Comments ()

I vividly remember my first encounter in the Intensive Care Unit (ICU): A young woman who had ignored a ruptured appendix lay dying of sepsis. All her organs had shut down, she was bleeding from everywhere, and there was little anyone could do. I, naively, was astounded that in the then late 20th century, almost 100 years after the discovery of antibiotics, people could still die from such infections in America. I unfortunately learned all too often that no matter how many antibiotics we develop, once our bodies begin to fall to an unrelenting infection, our systems shut down and can not come back. Therefore, every infection needs to be taken seriously.

According to the CDC, sepsis one of the top 10 causes of death in the US. Often, people can recover from early to mild sepsis, but there is a 50% mortality rate for those that develop late severe sepsis.

Overview

Sepsis is a serious multi-system potentially life-threatening complication that can occur with any infection. Once sepsis develops, it causes a series of chemicals reactions in response to, usually, a bacterial infection spreading throughout the bloodstream. This triggers a series of inflammatory reactions, which can increase both blood clotting and bleeding, then in turn damage organs and blood vessels causing multi-organ failure – eventually leading to septic shock as blood pressure drops. Once this cascade of reactions is initiated, the problem goes beyond just treating the infection. Despite antibiotics, which may kill the offending bacteria, once a person becomes severely septic, it is often too late and the end result is death.

Symptoms

Early sepsis must have at least two of the following abnormal vital signs or symptoms:

  • Fever over 101.3°F (38.5°C) or below 95°F
  • Heart rate over 90 beats/minute
  • Respiratory rate over 20 breaths/minute
  • A confirmed or probable infection

Severe sepsis has symptoms:

  • Mottled skin
  • Decreased urine output
  • Change in mental awareness or alertness
  • Decreased platelet counts (which are particles in the blood that promote clotting)
  • Difficulty breathing which usually requires being put on a ventilator 
  • Abnormal heart function usually leading to circulatory collapse and shock 

This is the next phase of sepsis called septic shock.

Article written by Leigh Vinocur, MD, FACEP
Board-certified Emergency Physician, Adjunct Assistant Professor LSU Health-Shreveport