Sepsis Patient - Transfer from Manila Philippines to Singapore
Transfer of an elderly patient who was diagnosed with septicemia on a ventilator from Lukes Hospital Manila Philippines to Mount Elizabeth Hospital in Singapore.
He was an elderly diabetic who had a bad urinary tract infection which went unnoticed and he was admitted to the hospital with fever, sweating, tachycardia and burning sensation while passing urine.
His condition deteriorated in spite of Antibiotics and he wanted to go back home to Singapore.
We flew in a Gulfstream 150 with an Intensive medical team who took care of his oxygen needs and provided all medical equipment back up in case his situation change during the travel.
His family safely received him at Seletar Airport and ground transported to the ICU in Singapore Hospital.
What is sepsis?
Sepsis is classed as a medical emergency.
Sepsis is a specific condition in itself, but it is commonly caused by bacterial infection in the blood, which is called septicemia. This explains why the terms sepsis and septicemia are often used together.
Septicemia leads to sepsis:
Poisons are released by the bacteria involved in septicemia
The immune system mounts a massive inflammatory response to these poisons - this is referred to as sepsis.
The current definition of sepsis is based on relatively recent developments in the scientific understanding of the condition. The disease process is also not fully understood, with treatment still proving highly challenging.
Sepsis is defined as "life-threatening organ dysfunction caused by a dysregulated host response to infection." In lay terms, sepsis is a life-threatening condition that arises when the body's response to an infection injures its own tissues and organs.
The signs and symptoms of sepsis following a bad infection are often subtle and can be mistaken for those of other serious conditions. However, sepsis typically involves the following main features in someone who has had a recent infection, and symptoms can come on quickly.
- Fever (high temperature, pyrexia), and there may be chills and shivering
- Fast heart rate/pulse (tachycardia)
- A rapid rate of breathing (tachypnea)
- Unusual levels of sweating (diaphoresis)
- It is particularly important to call for urgent medical help if sepsis has reached a late stage - severe sepsis or septic shock.
Call an ambulance whenever sepsis is suspected and there is:
- Dizziness or feelings of faintness
- Confusion or a drop in alertness, or any other unusual change in mental state, including a feeling of doom or real fear of death
- Slurred speech
- Diarrhea, nausea, or vomiting
- Severe muscle pain and extreme general discomfort
- Difficulty breathing - shortness of breath
- Low urine output (not needing to urinate for a whole day, for example)
- Skin that is cold, clammy, and pale, or discolored or mottled
- Skin that is cool and pale at the extremities, signaling poor blood supply (poor perfusion)
- Loss of consciousness
Causes of Sepsis
Bacterial infections are the most common cause of sepsis. Any bodily infection can trigger the condition and the lungs, urinary tract, and abdominal area are particularly susceptible.
Research shows that fungal infection-induced sepsis is also on the rise.
Older people are more at risk of sepsis due to aging and its effects on immunity. The likelihood of developing sepsis also increases following surgery.
Antibiotics alone may be sufficient in the early stages of the condition, but doctors need to provide treatment promptly. For sepsis that is discovered in its later stages, doctors may provide hospital treatment to a person in an intensive care unit. This may include:
- administering intravenous fluids
- using vasopressors
- using central lines
- initiating kidney dialysis
- administering other means of organ support as necessary
- In severe sepsis cases, surgery may be required. This often involves removing any tissue that the infection has damaged.
Sepsis in the Newborns
Sepsis can occur in neonatal infants or newborns. The infant will appear listless and unwell.
The risk is higher in infants:
- who are born preterm
- with a low birth rate
- with a low APGAR score
- if the mother experienced premature rupture of the membrane
- infection in the mother or the presence of group B streptococcus in the rectum or vagina
- It is more likely to occur in males.
Early onset sepsis appears before the age of 3 days and late-onset sepsis is when symptoms appear after 3 days of life.
The cause of sepsis in newborns can be viral, bacterial, or fungal. Viral causes include enterovirus, herpes virus simplex, or adenovirus. The most common bacterial causes are Escherichia coli (E. coli) and group B streptococcus (GBS), which can be passed on to the infant during delivery.
Risk factors affecting the chances of late-onset sepsis in newborns include medical treatment such as antibiotics, the use of a catheter or a feeding tube, or time spent in the hospital.
Complications include encephalitis and meningitis. Treatment is available, but sepsis can be fatal in newborns, especially those born preterm.
Sepsis in the Elderly
Older people have a higher risk of sepsis because of:
other existing conditions, such as cancer, diabetes, and others
time spent in the hospital, and especially in the intensive care unit (ICU)
functional limitations, due, for example, to muscles loss and neurological changes
the effects of aging
In older people, the early signs of sepsis may be harder to spot than in younger people, but as symptoms progress, the person's condition can deteriorate rapidly. Sepsis is most likely to stem from a respiratory tract problem or a genitourinary infection.
Treatment is available, but severe sepsis is fatal in 50 to 60 percent of cases among seniors. Early treatment is more likely to be effective.
Prevention of Sepsis
There are a few steps that people can take to reduce their risk of developing sepsis and septic shock:
Get regular vaccinations against viral infections, such as flu, pneumonia, chickenpox, HIV, and other infections that could potentially lead to sepsis.
Practice good hygiene, such as bathing and changing clothes regularly. Washing the hands frequently, especially after handling food, touching pets, and using bathroom facilities, is another way to keep infection at bay.
Care for and clean any open or gaping wounds. Wear disposable gloves, and rinse wounds with clean, soap-free water to clear out debris or dirt. Cover the wound to protect it, and see a doctor if the wound does not close or might still contain dirt.
Look out for signs of infection, such as fever, chills, rapid breathing, rash, or confusion.
For any bacterial infections, follow the doctor's advice on how to take the antibiotics and finish the whole course of treatment. Store the medicine according to the packaging instructions.
Treat fungal and parasitic infections as soon as symptoms appear, and use medication specific to the particular fungus or parasite.
Control diabetes, if relevant.
World Sepsis Day
World Sepsis Day is now held every year in order to raise the profile of this surprisingly prevalent and life-threatening condition. Prof. Konrad Reinhart, chair of the Global Sepsis Alliance, explains:
"We are appealing to the United Nation Member States and the WHO [World Health Organization] to take immediate action on their commitment to prioritize the devastation caused by sepsis worldwide, to issue a report on the prevalence and consequences of sepsis, and to support its member nations globally in the prevention, diagnosis, and management of this preventable global health issue."
There is still much to be done, however; as the press release for World Sepsis Day 2018 neatly claims, "In resource-rich countries with strong health systems, sepsis inflicts 500–700 per 100,000 population, according to new data from the United States and Europe, [which is] higher than the annual incidence of new cases of cancer."
It goes on to say that "[t]he majority of deaths from sepsis are preventable and can be reduced by 50 percent with appropriate measures."
This global event aims to put pressure on the WHO; they need to provide adequate resources to member states to help them implement better ways to manage sepsis. The protocols that were introduced in New York State may help guide future interventions to monitor and reduce risk.
Research papers on Sepsis
Sepsis accounts for considerably more hospital readmissions and associated costs than any of the four medical conditions tracked by the federal government to measure the quality of care and guide pay-for-performance reimbursements, according to an analysis led by the University of Pittsburgh School of Medicine and VA Pittsburgh Healthcare System.
The findings, published today in the Journal of the American Medical Association, highlight the need for coordinated efforts to develop new medical interventions aimed at improving sepsis outcomes and reducing readmissions.
Sepsis is the No. 1 killer of hospital patients and was defined last year by an international panel as a condition that arises when the body’s response to an infection injures its own tissues and organs, sometimes progressing to septic shock. According to the National Institutes of Health, it may occur in more than 1 million U.S. patients every year, and—despite best practice—an estimated 28 to 50 percent of these people do not survive.
“Many people think infections and sepsis are short-term illnesses and that once patients are discharged from the hospital, they are better,” said senior author Sachin Yende, M.D., M.S., associate professor in the Pitt School of Medicine’s departments of Critical Care Medicine and Clinical and Translational Sciences and vice president of Critical Care at the VA Pittsburgh. “But all research to date shows that sepsis has serious, lingering consequences, and patients continue to have problems well after they are discharged.”
The Centers for Medicare & Medicaid Services currently tracks readmissions for four medical conditions: heart attack, heart failure, chronic obstructive pulmonary disease (COPD) and pneumonia. A key component of the Affordable Care Act, the Hospital Readmission Reduction Program, penalizes hospitals if they have excessive rates of readmissions for these conditions.
Yende and his team analyzed data from the 2013 Nationwide Readmissions Database, which comprises 49 percent of U.S. inpatients, for the four conditions and sepsis. They revealed that sepsis accounts for 12.2 percent of readmissions, followed by 6.7 percent for heart failure, 5 percent for pneumonia, 4.6 percent for COPD and 1.3 percent for heart attack.
Sepsis also costs more. The estimated average cost per readmission for sepsis was $10,070, compared to $9,533 for pneumonia, $9,424 for heart attack, $9,051 for heart failure and $8,417 for COPD.
“This really puts in perspective how important sepsis is,” said lead author Florian B. Mayr, M.D., M.P.H., a faculty member in Pitt’s Department of Critical Care Medicine and the Center for Health Equity Research and Promotion at the VA Pittsburgh. “If we, as a nation, place such high emphasis on reducing readmissions for the other four conditions, then we really need to look for opportunities to improve outcomes for sepsis, which has a higher rate of readmission than heart failure. People who survive an initial episode of sepsis often don’t do well. They return to the hospital frequently, accrue new health conditions and have significantly elevated death rates.”
Questions and Answers about Sepsis
What bacterias can cause Sepsis?
Infection with these organisms may initially manifest as pneumonia or meningitis. Other causes of neonatal sepsis include Klebsiella and Enterobacter. The most common causes of sepsis in the pediatric age group include Streptococcus pneumoniae, Neisseria meningitidis, and Staphylococcus aureus.
What is the most common cause of Septic shock?
The most common cause of sepsis is a bacterial infection. Sepsis can then lead to septic shock. Whenever bacteria find their way into the bloodstream, serious infections might occur.
What is the first sign of Sepsis?
You must have one or more of the following signs to be diagnosed with severe sepsis:
patches of discolored skin.
changes in mental ability.
low platelet (blood clotting cells) count.
abnormal heart functions.
chills due to fall in body temperature.
How can sepsis be cured?
The main treatment for sepsis, severe sepsis or septic shock is antibiotics. If you have severe sepsis and septic shock, antibiotics will be given directly into a vein (intravenously). Ideally, antibiotic treatment should start within an hour of diagnosis to reduce the risk of serious complications or death.
What if we do not cure sepsis?
Septicemia occurs when a bacterial infection elsewhere in the body, such as the lungs or skin, enters the bloodstream. ... Septicemia can quickly become life-threatening. It must be treated in a hospital. If left untreated, septicemia can progress to sepsis.
What are the long term side effects of Sepsis?
Longer term effects of sepsis include:
Sleep disturbance including insomnia.
Experiencing nightmares, hallucinations, flashbacks and panic attacks.
Muscle and joint pains which can be severe and disabling.
Extreme tiredness and fatigue.
Inability to concentrate.
Impaired mental (cognitive) functioning.
Can you make a full recovery from Sepsis?
Because of problems with vital organs, people with severe sepsis are likely to be very ill. Up to 4 in every ten people with the condition will die. ... However, sepsis is treatable if it is identified and treated quickly, and in most cases leads to full recovery with no lasting problems.
What are the chances of surviving Sepsis?
The mortality rate of SIRS ranges from 6% to 7% and in septic shock amounts to over 50%. In particular, abdominal sepsis exhibits the highest mortality rate with 72%. The long-term prognosis is equally poor; only approximately 30% survived the first year after hospital admission.
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