Recognition, Prevention and Management of Sepsis

Anyone can be stricken with sepsis; however, some people are more at risk than others.


You are dispatched to a long-term nursing facility for a general illness call. Upon arrival, you find your patient lying in bed, soaked in sweat and responsive to pain only. The nursing staff tell you that Gerald is 76 years old, had a major stroke two years ago and is now nonverbal, but normally opens his eyes when his name is called. They also tell you he broke out with a fever of 101°F this morning and has had diarrhea for two days. You notice that he has a urinary catheter and a feeding tube.

     You begin a physical exam while your partner applies oxygen and obtains a set of vitals. As you inspect the patient's abdomen and examine the site where the feeding tube enters, you note that it is red and swollen, with pus seeping out around the tube. Your partner tells you that Gerald's pulse is 104, blood pressure 84/50, and his respirations are 28. After performing routine management, you alert the hospital that you are transporting a patient with suspected sepsis.

Introduction
     More than 750,000 patients are diagnosed with severe sepsis annually in the United States. Diagnoses have increased by over 90% in the last 10 years.1 One of the main reasons for this increase is the continual rise of drug-resistant bacteria.2 Further, 25 U.S. citizens die each hour from severe sepsis, making it more deadly than breast, colon/rectal, pancreatic and prostate cancer combined.1 Although most commonly seen in the hospital, sepsis often strikes patients in the prehospital setting.

Demographics
     Anyone can be stricken with sepsis; however, some people are more at risk than others.

Elderly population
     As people age, the effectiveness of their immune system begins to decrease, and it becomes much more difficult to fight off infections before they spread to the entire body.

     Dementia may impair a patient's ability to communicate illnesses. Additionally, many elderly patients have conditions, such as diabetes and cancer, that further impair their immune systems.4

Infants
     Premature babies and neonates have underdeveloped immune systems, making it very difficult for them to fight off infections. Infants born before 37 weeks gestation, as well as those born with meconium staining, are at high risk for developing sepsis. Mortality for septic infants is 50%.5

Surgical patients
     High-risk surgical procedures, such as heart or abdominal surgery, organ transplant and splenectomy, put patients at greater risk for sepsis. These patients often receive immunosuppressant drugs that impair their immune systems.4 These drugs are given to protect any transplanted organs or artificial organ parts, such as a heart valve, from being rejected by the recipient's body.

Pre-Existing Conditions
     Many conditions put patients at greater risk for infection. Chronically ill patients have already-stressed immune systems that are often too weak to fight off systemic infections. Chemotherapy administered to cancer patients impairs the immune system.4 Diabetics suffer from decreased peripheral circulation, which makes wound healing more difficult.

     Patients with gastrointestinal and gastrourinary problems are also at risk for infection, as are morbidly obese patients, who are generally less ambulatory, often bedridden and may develop bedsores, which are prime locations for infection development. Additionally, obese patients usually wait longer before seeking medical attention, delaying the recognition of infections. Major trauma and burns also put patients at risk for infections by destroying the body's natural protective barrier-the skin. However, sepsis may occur in an otherwise healthy person and can strike very quickly.

The following wounds carry a high potential for infection:

  • Impaled objects
  • Puncture wounds (e.g., dog bites)
  • Burns
  • Complex wounds (e.g., open fractures)
  • Crush injuries
  • Dirty wounds (full of debris).
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