Organizing a response to sepsis

Every year, more than one million Americans develop sepsis. Sepsis (sometimes called blood poisoning) is the body’s overwhelming, powerful immune response to an infection. This life-threatening response can lead to tissue damage, organ failure, and death. To address the risk, Parkview Community Paramedicine is working with 6 (six) nursing homes in Allen County to educate nursing home staff on what to look for and helping them be proactive in treatment. Betty Schroeder, MSL, EMT-P, PI, Community Paramedic, tells us more. 

Why do infections spread?
Sepsis is commonly caused by a bacterial infection in the blood, which is called septicemia.Usually, your immune system keeps an infection localized in one place. Your body produces white blood cells, which travel to the site of the infection to destroy the germs causing the infection. A series of biological processes occur, such as tissue swelling, which helps fight the infection and prevents it from spreading. This process is known as inflammation. If your immune system is weak or an infection is particularly severe, it can quickly spread through the blood into other parts of the body. This causes the immune system to go into overdrive, and the inflammation affects the entire body. This can cause more problems than the initial infection, as widespread inflammation damages tissue and interferes with blood flow. The interruption in blood flow leads to a dangerous drop in blood pressure, which stops oxygen reaching your organs and tissues.

Who is at risk for sepsis?
Sepsis can and does affect people of all ages. The very young and those who already have a chronic health problem (diabetes, kidney or liver disease, AIDS, and cancer) or a compromised immune system are at higher risk of developing sepsis, but two-thirds of all cases occur in people over the age of 65.  You can‘t catch sepsis from someone else, and most infections don’t lead to sepsis. It only happens inside your body, when an infection is present.

Around 40 percent of patients who get sepsis don’t survive – making it the 10th leading cause of death in the United States. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, and organ dysfunction (organs don’t work properly) and/or amputations.

Any type of infection can cause sepsis, from the flu to an infected bug bite, but the most common infections that trigger sepsis among older people are respiratory, such as pneumonia, or genitourinary, such as a urinary tract infection (UTI). Infections can also happen through infected teeth or skin sores, either from a simple skin tear, or a pressure sore from sitting in a wheelchair or lying in bed.

Prevention.
The key to fighting this dangerous condition is recognizing it early and treating it quickly. Sepsis can move into severe sepsis quickly, so getting help and treatment as quickly as possible is vital.

For every hour delay in appropriate treatment, the risk of death increases by 8 percent. Any infection should be taken seriously.

The key to preventing sepsis is to prevent an infection from occurring in the first place. Many illnesses can be and are prevented through regular vaccinations such as the flu or pneumonia. The risk also drops with proper hand washing. Infections can also be reduced by proper care of all wounds, even the smallest scrape or cut.  A thorough cleaning with soap and water will help remove any bacteria at the wound opening.

Symptoms.
It’s not always easy to spot an infection especially in the older person. If an older person becomes confused or behaves in an unusual manner, or if confusion or disorientation worsens, this could be a sign of an infection.

Signs of sepsis are generally the same among all adults, regardless of age:

  • Change in body temperature, either a fever (above 100.4 degrees F) or a lower than normal temperature (below 96.8).
  • Rapid heart rate (above 90 beats per minute)
  • Rapid breathing (above 20 breaths per minute)
  • Shaking
  • Confusion, which may be more common among older people

Treatment.
Sepsis is treated with IV fluids and antibiotics. Other medications, such as those to raise blood pressure may be needed. If someone is admitted to an intensive care unit (ICU), you may see many machines used to monitor various things, and perhaps a ventilator to help them breathe.

The role of Paramedicine.
Parkview Community Paramedicine is working with nursing homes in Allen County to educate nursing home staff on what to look for and helping them be proactive. Parkview community paramedics work closely with the physicians, nurse practitioners, and nursing home staff.  When nursing home residents meet two of the criteria (signs) of sepsis, they activate the sepsis response team.  The goal is to treat the patient in the nursing home by catching sepsis in the early stages and hopefully reduce hospital readmission rates.

When a sepsis response team activation is called, Parkview community paramedics respond to the nursing home. They first talk with the nurse to evaluate the patient’s symptoms and to communicate with a physician before seeing the patient.  The community paramedics perform vital signs and a visual assessment to look for any source of infection. They start an IV for fluid replacement, if recommended by the physician or nurse practitioner, and draw bedside labs. These tests give initial results right away.  The team also collects a urine sample and cultures to be done at the lab.

The paramedics return to do a 4-hour follow-up where they repeat the bedside labs and update the physician on the patient’s condition to update the care plan.

 

To learn more about Parkview’s Paramedicine program, read our post, “A new care model for Huntington County”.
 

blog comments powered by Disqus
© 2017 Parkview Health, Fort Wayne, Indiana
Privacy Policy