What is Sepsis
Sepsis (commonly called “blood poisoning”) is a potentially life-threatening medical emergency. According to the Centers for Disease Control and Prevention (CDC), each year in the US:
- At least 1.7 million adults develop sepsis.
- 1 out of 3 people that died in a hospital had sepsis during hospitalization or was discharged to hospice care.
According to the World Health Organization (WHO), sepsis causes 1 out of every 5 deaths. In calling for global action to decrease the incidence of sepsis, Dr. Tedros Adhanom Ghebreyesus, WHO Director-General called for rapid diagnosis and improved treatment of this deadly disease:
“The world must urgently step up efforts to improve data about sepsis so all countries can detect and treat this terrible condition in time. This means strengthening health information systems and ensuring access to rapid diagnostic tools, and quality care including safe and affordable medicines and vaccines.”
Diagnosing Sepsis: Signs and Symptoms
Sepsis diagnosis and treatment need to be done as quickly as possible, as sepsis can result in death in less than 12 hours.
The signs and symptoms of sepsis include:
- confusion or disorientation,
- shortness of breath,
- high heart rate,
- fever, shivering, or feeling very cold,
- extreme pain or discomfort, and
- clammy or sweaty skin.
We Urge Early Detection and Treatment of Sepsis
For the Physician-Patient Alliance for Health & Safety, sepsis is personal.
We conducted a podcast with Dr. Ken Rothfield, MD, MBA, about his experience with sepsis. Ken is also on our board of advisors.
At the time of the podcast, he was the Chief Medical Officer at Medical City Dallas. He is now Chief Medical Officer at Texas Health Resources Arlington Memorial Hospital. In the podcast, Dr. Rothfield emphasizes the need for early detection and treatment of sepsis and implores his colleagues to commit to the early detection and treatment of sepsis:
“I would like you to commit to early detection and treatment of sepsis, because you may not get a second chance to save your patient’s life.
“But, first, you have to know when your patient is suffering from sepsis. You must know at the earliest possible time when sepsis is occurring. Clinical studies show that mortality is significantly reduced if septic patients are identified at early stages of the disease process. In my own case, I was admitting on Thursday, by Friday I was septic, but it was not until Saturday that emergency surgery was performed which removed a section of gangrenous intestine. In my opinion, this can best be done through patient monitoring, which would have been able to provide early detection of my sepsis and I could have had earlier intervention.
“Monitoring a patient’s heart rate and respiratory rate allows clinicians to detect changes over time while supporting hospital protocols for early detection of sepsis. Although nursing assessments taken every few hours may detect sepsis, patient monitoring can alert you at the earliest possible moment when sepsis is developing.
“You may not get a second chance to save your patient’s life – monitor for sepsis.”
The podcast with Dr. Rothfield was commended by the Global Sepsis Alliance.
Stages of Sepsis:
There are 3 stages of sepsis:
- The First Stage of Sepsis occurs when your immune system overreacts to an infection.
- In the Second Stage of Sepsis, severe sepsis occurs which is when sepsis causes organs to malfunction.
- In the Third Stage of Sepsis, the patient is in septic shock and is a life-threatening condition that happens when blood pressure drops to a dangerously low level after an infection.
First stage: Sepsis
The First Stage of Sepsis can be hard to identify.
This is particularly true with children – “recognition of sepsis in children in the emergency department (ED) can be challenging, related to the high prevalence of common febrile infections, poor specificity of discriminating features, and the capacity of children to compensate until advanced stages of shock.” As Hassenfeld Children’s Hospital at NYU Langone Health warns, “Sepsis can be difficult to distinguish from an ordinary infection, especially in very young babies. Babies and children with sepsis may have a fever or a lower-than-normal temperature.”
In this First Stage of Sepsis, sepsis is typically associated with a suspected source of infection together with:
- Either a very high or very low body temperature
- A high heart rate
- A high respiratory rate
- A high or low white blood cell count.
Second Stage: Severe Sepsis
The Second Stage of Sepsis is also called “severe sepsis”. Severe Sepsis occurs when acute organ dysfunction begins and is associated with hypotension (low blood pressure), hypoperfusion (decreased blood flow through an organ), decreased urine output, sudden changes in mental state, decreased blood platelet count, difficulty breathing, abnormal heart pumping function, and abdominal pain.
American Thoracic Society describes the treatment for severe sepsis:
“Antibiotics and intravenous (IV) fluids are two of the most important treatments for sepsis. Studies have shown that delays in receiving the right antibiotics can double the risk of death. Patients are usually started on antibiotics that treat many different types of bacteria—’broad-spectrum antibiotics’—until test results are available to help physicians select antibiotics that treat the specific bacteria causing the illness—’narrowing antibiotics’. These tests are often referred to as ‘cultures’, where bodily fluids such as blood, urine, and phlegm, are sent to the laboratory to identify disease-causing bacteria. Preliminary results from cultures may be available within 24 to 48 hours; final results from these tests often take several days.”
Third stage: Septic Shock
The Third Stage of Sepsis occurs with the patient has septic shock and is the most difficult to treat. Septic shock is a life-threatening condition that happens when the patient’s blood pressure drops to a dangerously low level after an infection.
Time is critical to stop the progression of sepsis. The chances of sepsis progressing to severe sepsis (Stage 2 Sepsis) and septic shock (Stage 3 Sepsis) to death rises by 4% to 9% for every hour treatment is delayed.