After complaining of a sore throat only two days prior, on May 15, 1990, famed puppeteer Jim Henson woke up at 2am; he was having trouble breathing, and was coughing up blood. Henson agreed to go to the New York Hospital two hours later, and by the time he got there he couldn’t breathe on his own. He had abscesses in his lungs. After two cardiac arrests, he died the morning of May 16, 1990 at age of 53 from sepsis. It is widely believed that Jim Henson would have survived his bacterial pneumonia if he had gotten to the hospital just a few hours earlier.
The CDC’s National Center for Health Statistics estimates that the rate of sepsis is only becoming more prevalent. For example, the number of times people were in the hospital with sepsis or septicemia (another word for sepsis) increased from 621,000 in the year 2000 to 1,141,000 in 2008. 50 percent of people who develop severe sepsis die. The number of cases of sepsis and deaths from sepsis continues to increase in the United States. It is believed that the consistent rise in sepsis can be attributed to the following:
- the population is aging
- people have more chronic illnesses
- people are getting more invasive procedures, immunosuppressive drugs, chemotherapy, and organ transplants
- increasing antibiotic resistance
- increasing awareness and tracking of sepsis
Sepsis is a potentially life-threatening complication of an infection which occurs when chemicals released into the bloodstream to fight the infection trigger an inflammatory response throughout the body. This inflammation can trigger a cascade of catastrophic events that damage multiple organ systems, causing them to fail. In addition, blood pressure drops dramatically, which may lead to death. Sepsis swoops in and rapidly and silently does its dirty deed, only to vanish along with the life it has taken. A septic patient truly does appear to be in the grips of something invisibly evil.
Any type of infection (bacterial, viral or fungal) can lead to sepsis with the most common being:
- Abdominal infection
- Kidney infection
- Bloodstream infection (bacteremia)
Sepsis is more common and more dangerous if the patient is:
- Very young or very old
- Has a compromised immune system
- Has wounds or injuries, such as burns
- Has invasive devices, such as intravenous catheters or breathing tubes
- Has a UTI, pneumonia, cellulitis, meningitis or had surgical procedures
But don’t be fooled, anyone and everyone can become septic from infections – with the trigger being nothing more than the smallest insect bite or hangnail.
There is no single sign or symptom of sepsis. It is, rather, a combination of symptoms. Since sepsis is the result of an infection, symptoms can include infection signs (diarrhea, vomiting, sore throat, etc.), as well as ANY of the symptoms below:
- Hypothermia / Hyperthermia
- Heart rate >90 beats per minute (bpm)
- Low blood pressure
- Fast respiratory rate
- Altered mental status (confusion/coma)
- Edema (swelling)
- High blood glucose without diabetes
These conditions, together with renal and liver failure, cause cardiac collapse and respiratory failure. Sepsis is preceded by a period of altered mental status for approximately 24 hours before other signs develop. Fatigue, malaise, myalgia, nausea, and vomiting are common early signs. Fever develops, but declines to hypothermia in late stages. Elevated heart rate and respiratory rate develop as blood pressure becomes erratic. Blood pressure eventually drops dramatically as plasma shifts and vasodilation worsens. In essence, sepsis is the body’s runaway attempt to defend itself against an infection. A series of inflammatory and anti-inflammatory compounds are released that attack body tissues above and beyond the original infection. Perhaps the most damaging effect is intravascular clotting; the formation of clots inside blood vessels that deprives tissues of needed oxygen and can result in organ shutdown. Damaged blood vessels start oozing fluids, the kidneys cannot function, the lungs become stiff, causing breathing difficulties, and ultimately the circulation fails and blood pressure cannot be maintained.
Compounding the devastating effects of sepsis can actually be the very antibiotics administered to treat the underlying infection. In some cases, certain antibiotics can unleash toxic substances from the bacteria itself.
Sepsis should be treated as a medical emergency. In other words, sepsis should be treated as quickly and efficiently as possible as soon as it is suspected. A 2006 study showed that the risk of death from sepsis increases by 7.6% with every hour that passes before treatment begins. (Critical Care Medicine) As the saying goes, “Suspect Sepsis. Save Lives.”
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Article by Nancy Capelle, EMT, ERT, EMS-IShare