LAS VEGAS — The ability to recognize the symptoms of sepsis is critical for ICU workers in order to reduce the rate of sepsis-related deaths; but it is also important for O&P practitioners, according to Steven Simpson, MD, professor of medicine in the Division of Pulmonary and Critical Care at the University of Kansas.
Simpson was speaking on behalf of the Sepsis Alliance, a nonprofit organization working to increase awareness of sepsis. Simpson is a member of the board of directors.
Because sepsis is caused by infection, many groups within the O&P community carry a significant risk. Those at highest risk for sepsis include the very young and the elderly, patients with certain chronic diseases such as cancer and liver disease and people taking medications that affect the immune system.
“This happens to lots and lots of diabetics,” Simpson said. About 190 per 100,000 patients with diabetes per year, or 55,000 individuals, undergo an amputation each year due to sepsis.
In addition to killing more people in the U.S. than breast, lung and prostate cancer combined, severe sepsis leads to amputation of affected limbs in order to control the infection.
“Once it gets started, the only way to cut it off is to control the source of infection,” Simpson said.
Simpson said it is important to recognize what sepsis is and what it is not. A patient does not need to have hypotension or bacteria in the bloodstream in order to have sepsis, although both of these symptoms can occur.
Every case of sepsis has two criteria: it must start with an infection, and it must have two symptoms of systemic inflammatory response syndrome (SIRS). Any type of infection can cause sepsis but he most common are pneumonia, urinary tract infections and infections in the belly. SIRS symptoms include: a temperature greater than 100.4°F or less than 96.8°F; a heart rate above 90 beats per minute; more than 20 respirations per minute; and a white blood cell count of more than 12,000/mm³ or less than 4,000/ mm³ or greater than 10% bands.
Severe sepsis occurs when sepsis is combined with organ dysfunction, while septic shock occurs when sepsis is combined with hypotension despite fluid resuscitation.
Simpson said awareness of sepsis is crucial so that people can advocate for themselves and their loved ones.
“We need to get so that every American knows that this is not just a simple infection … They need to know to demand the right service.”
At the same time, Simpson emphasized the importance of taking action rather than just spreading education on the disease.
“None of this [information] would be important if there was not something we could do about it,” he said.
Simpson said a program with clear guidelines for addressing sepsis makes a difference for a hospital. “It is clear that since only 30% to 50% of people [with sepsis] die, that even if you do the wrong things, half of the people are going to live. But if you do the right things and you do them all the time, you bring your mortality rate steadily down,” he said. Before implementing guidelines at his ICU, Simpson said, the mortality rate for sepsis cases was 41%; now it is 9.2%. “We are still working on getting it lower. One [death] out of 10 [cases] is still too much for me.”
For anyone showing signs of sepsis, Simpson said the best action is to call 9-1-1 and mention sepsis. – by Amanda Alexander
Simpson S. Severe sepsis: common, deadly, unrecognized and germane to Hanger. Presented at: Hanger Education Fair and National Meeting. Feb. 3-6, 2015. Las Vegas.
Disclosure: Simpson reports no relevant financial disclosures.