what-you-need-to-know-about-sepsisIt seems like every time we turn around there’s some new life-threatening disease or medical condition we need to worry about. One such condition that is on the rise is sepsis, which can start out with a simple cut, but turn life-threatening in a matter of hours or days. The following article helps to understand this condition and how to be on the lookout for any signs and symptoms.

Information About Sepsis and Emergency Room Management
By J. Cutler

Emergency room physicians and their staff are some of the most important and well-known medical professionals. These doctors are often placed under enormous stress as they manage the diagnosis and treatment of several patients simultaneously; often the patients they treat are suffering from life-threatening illnesses or injuries. One medical condition that is becoming more and more common in emergency departments in the United States but which often goes unnoticed by the general public is sepsis.

This condition occurs when the body becomes overwhelmed due to infection with bacteria, a virus, or even fungi. The body’s systematic attempt to fight off these bloodstream intruders begins with a release of chemicals into the bloodstream – this then causes widespread inflammation, organ failure, and even death if not treated. Although few readers will have heard of sepsis, it costs the United States an average of $16 billion per year. It is also surprising that sepsis can appear quickly and without warning since it can develop from what is initially a minor infection. Those with altered immune systems are at highest risk.

As with most serious illnesses and injuries, early recognition of symptoms is often the key to successful intervention and recovery. Patients have the best chance when they are treated early on with powerful antibiotics (if the infection is due to bacteria) and large amounts of IV fluids. In patients with compromised immune systems such as the elderly, those with HIV/AIDS, and the very young, sepsis is more likely to occur and may also prove harder to treat once it has set in. Sepsis is normally viewed as a three stage process, where symptoms begin rather mildly, and then progress all the way up to severe sepsis and eventual septic shock. Sometimes, a routine infection like a urinary tract infection, influenza, or a staph infection can progress rapidly and unexpectedly to the first stage of sepsis. The abdomen, urinary tract, and lungs are three locations where infections are most likely to begin, but this is not true for all patients. For some, the original source of infection is never found.

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Initial symptoms that can indicate sepsis include a fever of at least 101.3, elevated heart rate (over 90 beats per minute), an elevated respiratory rate (to over 20 breaths per minute) and either confirmed or suspected infection. If caught during this stage, the sepsis can be treated and is somewhat less harmful. The next stage of sepsis (if it advances to that) is characterized by almost no urinary output (as the kidneys begin to fail), confusion or mental delirium, breathing problems, abnormal heart functioning, and stomach pain. This stage is somewhat more noticeable, and many patients seek treatment at this time either because they feel so poorly, or because their caregivers become aware of extremely unusual behavior.

The last stage is called septic shock, and it occurs when all of the previous symptoms appear along with extremely low blood pressure that does not respond to treatment with IV fluids. At this stage, patients may need more serious intervention such as assistance with breathing, dialysis to support failing kidneys, IV fluids, and medication to treat the source infection once it is identified.

The complications from sepsis vary, but since it is a condition that affects blood flow to other parts of the body, side effects can include loss of blood flow to the brain, damage to internal organs, and even blood clots. Sadly, 50% of the patients who enter the third stage (i.e. septic shock) do not survive the episode, which is one reason why emergency physicians must work quickly to diagnose the problem before it becomes severe and therefore untreatable.

ER physicians and staff will work to analyze patients’ blood and organ functioning as soon as an infection is suspected. Blood tests can be used to look for infection (in the blood itself), clotting problems, liver or kidney failure, and imbalances that would lead to dehydration. If there is an open wound or other source of infection that is easily accessible, then it can be tested to figure out which pathogen is likely causing the infection. If the infectious agent is known, it is easier to select the correct antibiotic or antiviral medication. If blood work does not reveal the source of the problem, then other tests like x-rays, MRIs, ultrasounds, and CT scans can also be used to look for the source of infection.

The emergency department will handle most aspects of care for a patient who is brought in and is suffering from sepsis. For some patients, the extra support of assisted breathing device and dialysis may be enough to stabilize bodily functioning while the antibiotics are administered. For other patients, treatment by a qualified surgeon to remove the infection (as in the case of abscesses) may be needed. In cases where the infecting agent is highly resistant or unknown, the input of an infectious disease specialist or pathologist may be requested. Regardless, the earlier a patient is diagnosed and treated, the better the chances of a full recovery.

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