Winter is Coming: Sepsis

What is sepsis?

It is not a specific illness with one specific cause, but is a syndrome (a constellation of symptoms that occur together). It is caused by an infection that results in a chaotic inflammatory response.

What causes sepsis?

Sepsis is caused by viruses, bacteria, and fungi. Often times, bacteria in the blood, called bacteremia, is the cause of sepsis.

What are the symptoms of sepsis?

  • Temperature >100.4 F or <96.8 F
  • Heart rate greater than 90 beats per minute
  • Respiratory rate greater than 22 breaths per minute
  • On labs, white blood count is usually very high or very low

In severe sepsis, there is evidence of organ failure that needs to be quickly corrected. Someone with severe sepsis may be confused or lethargic, have trouble breathing, have decreased urine output, be very flushed or cool and clammy.

How do you know if you have sepsis? What tests would need to be run if there is concern for sepsis?

Sepsis is usually diagnosed in the hospital or clinical setting. There are many tests that may be run if a physician is concerned for sepsis since it can’t be so deadly.

  • Lab work: blood counts, liver function, kidney function
  • Cultures: urine cultures and blood cultures
  • Imaging: X-rays, ultrasounds, or CT scans may be necessary to isolate the source of infection.
  • Echocardiogram may be necessary if there is confirmed bacteria in the blood. This test will ensure that no bacteria has infected the heart valves.

How do you treat sepsis?

  • Antibiotics: Initially the physician will start “broad spectrum” antibiotics that target many types of bacteria and can reach most areas of the body. As the infection is isolated and identified, then antibiotics are narrowed down to only those that are necessary.
  • Surgery or procedures may be necessary to rid the body of infection. Abscesses must be drained.
  • Supportive care: IV fluids are always given to ensure that the patient’s blood pressure stays high enough to prevent organ damage. If this proves ineffective, physicians must start medications which artificially keep the blood pressure up. These must be infused through a special IV that goes in through the neck or chest and blood pressure must be monitored through an arterial like, which is usually inserted in the wrist.
  • Sometimes patients will need a ventilator to breathe for them or dialysis if their kidneys temporarily stop working.

Who is at risk?

  • Age >65
  • Those on immunosuppressive drugs (chemotherapy, long term steroids)
  • Patients with cancer
  • Patients who have diseases that cause immunocompromise (HIV, renal failure, liver failure)
  • Diabetic patients
  • Obesity

Can it be prevented?

Seek attention immediately if you think you may have an infection.

Prevent infection by washing your hands frequently and getting your vaccinations. Immunizations are key in preventing infection!

If you are a patient who is at risk for sepsis, ensure that the people closest to you do not come around when they are sick. Ask them to get their vaccinations in order to protect you.

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