SEPSIS

Sepsis is a serious illness. It happens when your body has an overwhelming immune response to a bacterial infection. The chemicals released into the blood to fight the infection trigger widespread inflammation. This leads to blood clots and leaky blood vessels. They cause poor blood flow, which deprives your body's organs of nutrients and oxygen. In severe cases, one or more organs fail. In the worst cases, blood pressure drops and the heart weakens, leading to septic shock (multisystem failure - shock).

• Anyone can get sepsis, but the risk is higher in:

-people with weakened immune systems

-infants and children

-the elderly

-people with chronic illnesses, such as diabetes, AIDS, cancer, and kidney or liver disease

-people suffering from a severe burn or physical trauma

This response may be called systemic inflammatory response syndrome (SIRS).

Causes

The symptoms of sepsis are not caused by the germs themselves. Instead, chemicals the body releases cause the response.

A bacterial infection anywhere in the body may set off the response that leads to sepsis. Common places where an infection might start include the:

-bloodstream

-bones (common in children)

-bowel (usually seen with peritonitis)

-kidneys (upper urinary tract infection or pyelonephritis)

-lining of the brain (meningitis)

-liver or gallbladder

-ungs (bacterial pneumonia)

-skin (cellulitis)

For patients in the hospital, common sites of infection include intravenous lines, surgical wounds, surgical drains, and sites of skin breakdown, known as bedsores or pressure ulcers.

Symptoms

In sepsis, blood pressure drops, resulting in shock. Major organs and body systems, including the 

kidneys, liver, lungs, and central nervous system stop working properly because of poor blood flow.

A change in mental status and very fast breathing may be the earliest signs of sepsis.

In general, symptoms of sepsis can include: chills, confusion or delirium, fever or low body temperature (hypothermia), light-headedness due to low blood pressure, rapid heartbeat, shaking, skin rash and warm skin. Bruising or bleeding may also occur.

Fast action is key to prevent sepsis death:

Full article at: https://medlineplus.gov/news/fullstory_160574.html

Following the recommendations of The UK Sepsis Trust we can assess our patients easily. If our patient looks sick or the New Early Warning Score has triggered we should wonder if there is an infection present even if the source is not clear yet.

If there is an infection, we should look for ANY Red Flag Criteria:

If one of the above is present, the Sepsis 6 pathway should be started immediately. If none of the above is present we should look for any Amber Flag criteria:

If there is an Amber Flag criteria present a set of routine blood samples and an urgent senior review should take place within an hour, if Acute Kidney Injury is present the Sepsis 6 pathway should be started.

Sepsis 6 pathway

When the Sepsis 6 pathway has to be started, a treatment escalation plan should be made and the CPR status of the patient should be clarified. The patient has Red Flag Sepsis and all the following actions have to be completed within one hour:

If after delivering the Sepsis Six, the patient still has:

-systolic BP < 90 mmHg

-reduced level of consiousness despite resuscitation

-respiratory rate over 25 breaths per minute

-lactate not reducing

or the patient is clearly critically ill at any time, Critical Care Outreach team should be called immediately.

Sources:
-http://sepsistrust.org/
-https://medlineplus.gov/ency/article/000666.htm
-https://medlineplus.gov/news/fullstory_160574.html
-https://www.emaze.com/@AOZTZRZO/CAMPA%C3%91A-PARA-SOBREVIVIR-A-LA-SEPSIS.pptx