About Medicine: Sepsis; What It Is and How to Survive
Jennifer Feighner, MD, Hospitalist
Marcus Daly Memorial Hospital
1200 Westwood Drive
Hamilton, MT 59840
The red spot appeared on her right foot on Friday afternoon. Being a diabetic,
Carla checked her blood sugar, it read 130, a good range for afternoon.
"I'll have to keep an eye on this spot" she told her husband,
George, "I'll call my doctor's office on Monday if it's
still there." She went back to folding the laundry. By next morning,
she awakened feeling feverish. "What's my temperature?"
"You're burning up" her husband answered. "George,
look at my leg!" From the spot on the foot, all the way up to her
knee, was a bright, angry fire engine looking red. It was painful and
warm to touch. She checked her blood sugar, it was 230. George noticed
Carla was breathing rapidly and more heavily than usual. "We'd
better get you in right now, that leg looks bad. I'm not sure what's
going on, but you don't look good."
Infections can start just the way Carla's did. A small problem, that
can become a big problem very quickly, especially for those patients with
underlying health conditions such as diabetes which makes it harder for
the body to fight infections. Carla has an infection of the skin known
as cellulitis, but other infections can have more subtle presentations.
For example, a urinary tract infection in an older person can present
with low grade fever, fatigue, confusion and weakness, rather than the
classic symptoms of young people who often have increased urinary frequency
and pain on urination. If a urinary infection spreads to the kidneys it
can cause lower back pain as well. Other common infections include pneumonia,
which cause cough, fever, chills and fatigue or weakness as well. Colitis,
infection or inflammation of the colon, is also common, and usually causes
lower abdominal pain and diarrhea with fever and chills. Sometimes fever
can occur by itself, but no obvious cause of the fever is ultimately found.
Carla and George went to Convenient Care, where Carla was checked in while
waiting to be seen by the Nurse Practitioner. Her blood pressure read
96/50, heart rate 100. Her temperature was elevated at 101.5 and she was
breathing about 25 times per minute. The Medical Assistant who checked
Carla in saw her red leg and brought her vital signs to the practitioner
in charge, who saw Carla right away.
"Carla," she said with a concerned tone. "Your blood pressure
is low, your heart rate is fast, you are breathing fast and have a fever
with a large infection on your leg- you have a condition called sepsis
from your leg infection, also called cellulitis, and you need to go over
the Emergency Department right away." She was taken to the Emergency
Department in a wheelchair, where she had blood cultures and other labs
drawn, and was started on IV antibiotics and IV fluids by the Emergency
Medicine physician and Emergency Department team.
Sepsis is a condition where the body has an inflammatory response to infection.
There are many stages of sepsis, ranging from mild sepsis to septic shock,
where the blood pressure drops and the patient requires intensive care
for management. Carla had symptoms consistent with sepsis to severe sepsis:
She had a high temperature, rapid heart rate, rapid rate of breathing
(known as the respiratory rate), and her blood pressure was borderline
low, all in the setting of cellulitis (infection on the skin of her leg).
All of these are classic symptoms of severe sepsis. It is extremely important
to recognize sepsis and have it treated immediately. The main treatments
are IV Fluids and IV antibiotics. Sometimes, such as in shock, where the
blood pressure remains low despite IV Fluids, the patient requires specialized
medications known as pressors to keep the blood pressure high enough to
stay within normal range.
Severe sepsis and septic shock can also result in damage to other organs
such as the kidneys - patients may notice that their urine decreases or
changes color. Confusion can also occur as inflammation from sepsis and
low blood pressure can affect how the brain works. Heart attack, or strain
on the heart, can also occur in the setting of severe sepsis or septic
shock. The earlier the patient receives IV fluids and IV antibiotics,
the better the outcome.
The Surviving Sepsis Campaign was created in 2002 due to the high mortality,
or death rate, from sepsis. This campaign has resulted in increasing survival
from sepsis by increasing the amount of IV fluids patients with sepsis
receive, focusing on how quickly they get fluids such as in the ambulance
if patients come in by that route, and decreasing time to IV antibiotics.
Here at Marcus Daly Memorial Hospital, we have sepsis protocols both in
the ED and in the ICU for improving survival and recovery time from sepsis
that follow these national guidelines. These protocols nationwide have
resulted in reducing mortality from severe sepsis or septic shock, saving
thousands of lives through these improved protocols. Blood sugar control
in patients with diabetes helps improve outcomes as well, as blood sugar
can be very elevated.
You can save your life, or the life of someone you love, by knowing and
recognizing the signs of sepsis from an infection: in early stages fever,
rapid heart rate, increased rate of breathing, with potential for more
serious and advanced symptoms such as confusion, weakness, decreased urination,
dry and warm skin and low blood pressure, lethargy and poor responsiveness.
Remember, the sooner sepsis is recognized and treated with fluids and
antibiotics, the better the outcome. The persons/patients portrayed in
this health column are fictitious, although the series of events does happen.
The weekly health column is brought to you by Marcus Daly Memorial Hospital
and the Ravalli Republic. For questions regarding this week's health
column please contract, Jennifer Feighner, MD Hospitalist at Marcus Daly
Memorial Hospital, 1200 Westwood Drive, Hamilton, MT 59840. Working together
to build a healthier community!