August 23, 2011 > Learn About the Signs & Symptoms of Sepsis
Learn About the Signs & Symptoms of Sepsis
Every year, severe sepsis strikes about 750,000 Americans, according to the National Institutes of Health (NIH), and it's estimated that the death rate among those stricken with severe sepsis is around 40 percent. Sepsis is the 10th most common cause of death in the United States, yet nearly 60 percent of Americans don't even know what sepsis is.
"Sepsis is caused when the body has an overwhelming immune response to infection," says Katie Choy, RN, Washington Hospital's Sepsis Project Director and Nursing Director of Patient & Staff Education. "Sepsis can progress rapidly. The immune system releases natural chemicals into the blood to combat infections. An overload of those chemicals can result in widespread inflammation and impaired blood flow that damages the body's organs."
If the condition becomes severe, the patient can experience failure of one or more organs. The body's blood pressure can drop dramatically, sending the patient into septic shock, at which point multiple organs may fail and the patient can die.
Anyone can get sepsis, but the elderly, infants and people with weak immune systems or people undergoing chemotherapy are most vulnerable. People with diabetes and other chronic illnesses such as cancer and kidney, lung or liver disease also are at increased risk.
"Early diagnosis and treatment of sepsis can be life-saving," Ms. Choy asserts. "That's why it's important for people to be aware of sepsis."
To help people in the community learn more about sepsis, Washington Hospital is sponsoring its third annual seminar on the topic. "Treating Infections in the Body - Learn About Sepsis" will feature presentations by Emergency Medicine physician Naveenpal Bhatti, M.D., Critical Care physician Carmencita Agcaoili, M.D. and Katie Choy, RN. The seminar is scheduled for Tuesday, August 30 from 1 to 3 p.m. in the Conrad E. Anderson, M.D. Auditorium at the Washington West Building, 2500 Mowry Avenue in Fremont.
Dr. Bhatti notes that any type of infection can lead to sepsis. "Pneumonia and urinary tract infections are by far the most common causes of sepsis," he says. "Other less common sources of sepsis are infections of the gastrointestinal tract - including the bowel - and central nervous system infections such as meningitis. Even an infected wound can end up in sepsis, which is a special concern with patients who have diabetes because they sometimes can't feel their feet and aren't aware of wounds there."
The majority of sepsis cases are first encountered in hospital emergency rooms. "Sepsis usually presents a spectrum of symptoms including a fever above 101.3¼, chills and shaking, rapid or difficult breathing, a fast heart rate, confusion or disorientation, low blood pressure and a probable or confirmed infection," Dr. Bhatti explains.
"Of course, some of these symptoms are present in other conditions, but it's the combination of symptoms we are considering, and they can vary from case to case," he adds. "Simply having a fever is not an indication you have sepsis. In fact, some older patients with sepsis actually can have an abnormally low body temperature. The symptoms also can vary depending on the original source of infection. For example, a patient with moderate sepsis due to a urinary tract infection may not experience rapid breathing."
If sepsis is suspected, blood tests can be used to evaluate a number of factors that are common with sepsis:
* A high white blood cell count indicating infection.
* A low red blood cell count (anemia).
* Various chemicals in the blood that may be evidence of poor liver or kidney function caused by organ failure.
* An abnormally high blood level of lactate, an acid that is produced when oxygen levels in the body drop.
* Blood clots.
"We also use blood tests to figure out what types of bacteria are growing in the body and which antibiotics are appropriate to treat the specific underlying infections," Dr. Bhatti says.
Other tests might include urine analysis for urinary tract infections, mucus sample testing for respiratory infections or sampling of wound secretions in infected wounds. If the site of infection is not obvious, the doctor may order diagnostic imaging tests such as X-rays, computerized tomography (CT) scans, ultrasound or magnetic resonance imaging (MRI).
Early Treatment Is Key
"In patients with suspected sepsis, we may start treatment right away with three types of broad-spectrum antibiotics that kill many types of bacteria," says Dr. Bhatti. "Then, after blood tests have pinpointed the infection-causing bacteria, we can choose medicines that specifically target the infectious agents."
Many sepsis patients also require oxygen and intravenous fluids to maintain normal blood oxygen levels and blood pressure.
"In the ER, we make sure we have good IV access, using a 'central line' IV that is typically inserted in the groin, neck or upper chest wall rather than in the arms or legs," Dr. Bhatti notes. "The central line provides an easier and more permanent source of access. It also allows us to closely monitor the need for IV fluids as well as the central venous blood pressure - the blood pressure at the core of the body."
After initial treatment in the ER, patients generally are admitted to medical wards or the Intensive Care Unit (ICU) for continued care. Some patients with severe sepsis-related problems may require additional treatment such as a ventilator to help them breathe or dialysis for kidney failure. Surgery may be needed to remove abscesses (collections of pus) or other local sites of infection. Patients also may require ongoing treatment for underlying conditions such as diabetes.
Leading the Way in Sepsis Mortality Reduction
Washington Hospital has taken an aggressive approach to reducing the number of deaths due to sepsis. The Sepsis Project was initiated in 2007 with a generous grant from the Gordon and Betty Moore Foundation. An additional grant from the foundation in 2008 helped expand the efforts to achieve significant hospital-wide reductions in sepsis mortality rates.
"During the past several years, we focused primarily on efforts in the ER and ICU, developing protocols and instructing staff to recognize the signs of sepsis and treat it aggressively," says Ms. Choy. "We set a goal of reducing sepsis deaths among patients by 25 percent, and we actually achieved a 29 percent reduction. A lot of other healthcare systems have followed in our footsteps in taking action against sepsis."
The hospital also works in partnership with other organizations to promote better management of patients with severe sepsis. In addition, the hospital's sepsis team recently launched a research study that will be presented at the International Sepsis Forum conference in Beijing, China in October.
"We decided that we needed to reach out to the community to create greater awareness of sepsis," Ms. Choy explains. "One of our efforts is to educate the public to recognize when someone is showing signs of sepsis and to get medical care promptly. We believe steps like this can help prevent a lot of people with sepsis from getting worse or dying."
To register to attend the upcoming seminar on August 30, visit www.whhs.com. For more information about sepsis, visit the Sepsis Alliance website at www.sepsisalliance.org.