Bottom Line: This widely misunderstood medical emergency can kill within hours…
When it comes to medical emergencies, we all know that heart attack, stroke and asthma attacks are among the most serious. But there’s a medical emergency that most people don’t know about even though it kills 270,000 people in the US each year. That’s one death every two minutes…and more deaths than those caused by prostate cancer, breast cancer and AIDS combined.
This runaway killer is known as sepsis. It is a life-threatening condition that occurs when the body goes into overdrive to fight an infection, such as pneumonia, the flu or even a urinary tract infection.
Sepsis causes a deadly cascade of events when the chemicals that the immune system releases into the blood to fight infection trigger inflammation throughout the body that leads to tissue damage, organ failure and death. If not recognized and treated promptly, sepsis can worsen—and kill—within a matter of days…or even hours.
Latest development: New efforts are under way to help people identify sepsis more quickly and get the right treatment promptly so they can survive this devastating illness.
What you need to know to protect yourself and your family…
While anyone who is battling a bacterial, viral or fungal infection can develop sepsis, the old and very young are at particular risk. So are people with chronic diseases such as diabetes, cancer, chronic obstructive pulmonary disease (COPD) and kidney disease.
Sepsis is commonly misdiagnosed because its symptoms—including fast breathing (greater than 20 breaths per minute—the normal rate is 12 to 20)…a racing pulse (above 90 beats per minute)…the chills…pale, clammy skin…and extreme fatigue—can be mistaken for any number of health problems such as heart attack, stroke, pulmonary embolism, exacerbations of chronic lung disease or heart failure.
Misdiagnosis also can occur because there is no definitive test for sepsis—it is diagnosed based on a checklist of signs and symptoms.
To help people identify the red flags of sepsis, the Sepsis Alliance has created the TIME acronym…
Temperature: It can be either above normal (such as 100.4°F or higher) or below normal (such as 96.8°F or lower). Severe chills or burning fever are common.
Infection: It may be obvious, such as the flu or an abscess, or there could be less obvious signs and symptoms, including intense pain in some part of one’s body, profound weakness or loss of appetite for both food and water.
Mental decline: People with sepsis are often confused or disoriented. They may be very sleepy and hard to rouse.
Extremely ill: Sufferers often experience intense, sharp pain in the chest, belly or elsewhere. They may be short of breath. Many survivors recall, “I felt like I was going to die.”
If you think you may have sepsis, seek immediate medical attention. If your doctor isn’t available, call 911 or get to an emergency room.
Important: Whether you’re seeing your own physician or an ER doctor, make sure he/she knows your concerns. Ask straight out: “Could this be sepsis?” Don’t be shy about pushing for tests for impaired organ function such as creatinine for kidney function, lactate (lactic acid) level, platelet count, bilirubin and liver enzyme studies.
Keep in mind that the diagnosis of sepsis is missed completely about half of the time—and a delay in treatment can be fatal. Untreated sepsis can rapidly turn into shock, in which blood pressure plummets and tissues are starved for oxygen and nutrients. For every hour that treatment is delayed, the likelihood of septic shock increases.
The latest sepsis practice guidelines, jointly issued by American and European critical care medicine societies, more strongly emphasize the urgency of sepsis diagnosis and treatment.
Under these guidelines, a main goal is to eradicate infection with antibiotics that cover a wide variety of bacteria. Equally important is raising blood pressure to restore delivery of oxygen and nutrients to the organs and normalize their ability to function. This means intravenous fluids and, if needed, vasopressor drugs, such as norepinephrine, that stimulate the heart and tighten blood vessels to improve function.
Drugs to reduce immune system activity, once a mainstay of treatment, are no longer standard, reflecting a better understanding of the complex biology involved. Instead, researchers are exploring the use of anti-inflammatory drugs early in the condition’s course and immune-stimulating drugs later.
Another change involves medical centers’ adoption of highly organized procedures to bring optimal treatment to their patients in the shortest time.
For example, in New York State, which mandates this approach, patients who were diagnosed and treated for sepsis after three hours (and up to 12 hours) of an exam were 14% more likely to die in the hospital than those treated within three hours, according to a 2017 study published in The New England Journal of Medicine.
To be alert for possible sepsis: If you have a loved one in the ICU, ask the doctors every day if there are signs of infection, especially if the person is on a mechanical ventilator.
Scientists are discovering increasing evidence that the effects of sepsis can linger. Up to half of survivors suffer “post-sepsis syndrome” (PSS). Physical aspects of PSS reflect damage to vital organs and other tissues. There can be impaired breathing and liver and kidney function, which are often irreversible. Gangrene due to tissue death caused by infecting organisms can necessitate amputation. Fatigue and muscle and joint pain are sometimes disabling.
Recent discovery: The long-term mental impact has only recently been recognized. This may include insomnia, hallucinations, panic attacks, poor concentration, impaired memory and even post-traumatic stress disorder (PTSD).
While the reasons for such mental effects are not yet known, it’s believed that sepsis may disrupt the protective blood-brain barrier, leaving the brain vulnerable to damaging inflammation.
Medications used in the ICU—especially sedative agents, including benzodiazepines such as midazolam (Versed)—also may have negative effects on mental functioning, sometimes lasting for years.
Much remains to be learned about PSS, but it seems likely that quick action early in the course of sepsis could cut the risk.
The key to preventing sepsis is to prevent infection. To do this…
• Get recommended vaccinations, including yearly flu shots and vaccination against pneumonia. Also: Sepsis can occur with shingles if the skin becomes infected with bacteria. This is an additional reason to consider getting the shingles vaccine.
• Practice good hygiene. Wash your hands frequently and thoroughly (for at least 20 seconds).
• Clean any cut, scrape or burn quickly and apply antiseptic or antimicrobial cream. If a wound shows signs of a worsening infection—redness, swelling, red streaks radiating up the arm or leg—seek immediate medical attention.
Note: Sepsis is not generally contagious, but some infections that cause sepsis are, such as plague or meningococcal meningitis.
