Sepsis: What patients don't know could kill them


 
Justin Glasgow MD PhD

Teaching people to recognize signs of a heart attack, stroke and cancer has made a real difference in improving outcomes. However, one of the most common causes of death is something many people have never heard of--and even many physicians are surprised when they see the numbers in black and white.

That killer is sepsis. Although the underlying condition might be pneumonia, flu, an injury or almost any health issue that may be complicated by infection, what may actually kill the patient is sepsis. At an average of a million cases a year, 30 percent more people in the United States have sepsis than a heart attack.

Not knowing that sepsis can happen or how to recognize its early signs puts patients at risk of not realizing they need to seek care until the window of opportunity for helping them survive is already closing.

"Only about 15 percent of sepsis cases develop after the patient presents at the hospital," UAB physician advisor for sepsis Justin Glasgow MD, PhD, said. "It is a life-threatening medical emergency caused by an overwhelming response to an infection. The immune system attacks the body's own organs, which may begin to shut down. Early recognition and treatment are critical."

Sepsis can quickly turn into septic shock, and the blood pressure begins to plummet. Up to 40 percent of patients with severe sepsis die and half of the survivors suffer from lingering damage. Alabama's high rates of diabetes, obesity and kidney disease increase the incidence of sepsis and reduce recovery rates. Sepsis has also been identified as the most expensive in-patient cost in American hospitals.

Glasgow, a quality and performance improvement hospitalist, said, "Through UAB's comprehensive sepsis care plan, we work to maximize the chances for survival. Preventing sepsis is our first priority. Our care team monitors patients throughout the day to identify early signs of a developing problem so we can start treatment immediately."

All acute care patients are frequently assessed by the nursing staff and their qSOFA (quick sequential organ failure assessment) scores are monitored. If a problem develops, a Code Sepsis can be called quickly, and the sepsis emergency team rushes to the bedside to begin treatment.

"Kimberly Glanding, RN and Mary Grace Cox, RN are two members of our team who do a tremendous job of keeping sepsis top of mind and teaching our staff. We also use simulations to train our residents and advanced practice providers in detecting and managing sepsis. Practice in teamwork and communication are an essential part of that training," Glasgow said.

When sepsis is detected, therapy usually includes antibiotics, intravenous support for blood pressure and possibly more aggressive treatment for the underlying condition and other symptoms.

Physician offices and walk-in clinics should also be on guard and watch for symptoms that might suggest more trouble could be coming. Patients should be reminded to follow up if symptoms get worse or any new problems develop.

Given that the majority of sepsis cases are already developing and may be quite serious by the time a patient arrives at the hospital, the big question is what can the medical community do to prevent sepsis, or to help patients recognized that they need to seek help sooner?

"Preventing the conditions that most often lead to sepsis is a good place to start," Glasgow said. "Patients should be encouraged to get flu shots, pneumonia vaccinations and to take care of their health. That is especially true of people who are most at risk of sepsis, including the elderly, people who are immune compromised, as well as those who undergo treatment or take medications that may affect their immunity, and patients with multiple health problems.

Just as diligent infection control measures are always important in hospitals and other medical settings, patients should also receive after care education on how to prevent infections in wounds or incisions, and the best ways to avoid picking up communicable illnesses in the community and where they work, as well as from other family members at home.

Other possible indications include shivering or feeling very cold, decreased urination, pain or extreme discomfort, pale or discolored skin, and weakness.

Most of all, patients, their families and caregivers should learn to recognize the warning signs that it's time to seek help, particularly if they are now experiencing a condition that could lead to sepsis.

"Watch for a new fever or dizziness that might indicate a drop in blood pressure," Glasgow said. "Is the patient confused or difficult to wake? Is the pulse faster or is breathing more difficult?"

One of the most important things to remember is to act.

"When sepsis is suspected, every hour of delay can reduce the chances that a patient will survive," Glasgow said. "The faster treatment begins, the better the odds are that we will see a good outcome."

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Tags:
immune response, infection, Justin Glasgow MD PhD, overactive immune response, qSOFA, Sepsis, UAB Medical Center

 

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