Contributors: Mariah Rossi and Dr. Emran
Dr. Emran is joined by one of his nurses, Frankie, who is an experienced ER nurse. They discuss the deadly disease Sepsis, which occurs when the body’s response to fight infection is out of balance and causes damage to different organs in the body. Frankie talks about the common signs of sepsis and how it is treated in the ER.
They discussed the case of a 35-year-old male who came into the ER looking dizzy and confused. Frankie describes that when people come into the ER in that condition, the first thing to do is rule out other possibilities, including the heart problems, blood clots, strokes, drug overdose, and infection. Vitals are checked, including blood pressure, temperature, oxygen, and heart rate. This man didn’t have any injuries, but had a very high temperature of 103℉ and a heart rate of 120. He already met several criteria for sepsis.
During the treatment process, the patient is placed into a gown to lower body temperature and IV fluids are immediately initiated. Dr. Emran describes that sepsis guidelines require “resuscitation,” which means giving as much IV fluid as possible to the patient. In this case, they gave him almost 3 liters of fluid, which was based on his weight. It is impossible to drink 3 liters of fluid, but that was how much fluid this man required
The next step is testing. Blood work looks for high white blood cell count, blood sugar, kidney function, liver function, and lactic acid levels. As soon as a high white blood cell is seen and lactic acid levels are high, they draw blood cultures and immediately start antibiotics. Dr. Emran explains that Blood cultures are taken in two sets (one from the right side and one from the left) to see if there is bacteria in the bloodstream. The old name for sepsis was blood poisoning, which is due to bacteria circulating throughout the body. Lactic Acid is a byproduct of sepsis, high body temperature, and muscle breakdown. Elevated levels will increase as there is more damage to the body.
The antibiotics are given immediately, even before the sepsis confirmation. Usually, these are 2 antibiotics that cover the “common infections.” Frankie describes that the most common infections are determined by their history. If the patient is diabetic, they are prone to sepsis, appendicitis, pneumonia, kidney infections, bone infections, meningitis. Frankie notes that the patient was probably sick for several days before he came into the ER. They did an X-ray and a CT Scan discovers that the patient had an intestinal infection.
After he was given fluids, the patient was feeling much better. This brought his fever down significantly, his blood pressure normalized, and his heart rate went down. Also, the labs were trending back down to normal.
He was then admitted to the ICU for monitoring. Despite him feeling a lot better with the fluids and antibiotics he still had a high risk of relapsing. When treating sepsis lot of people initially feel better and want to go home, but doctors must admit them into the ICU because of the relapsing risk. About 50% of people who are treated for sepsis, will die. Frankie describes that is because the body goes into multiple organ failure including the lungs, kidney, brain, or heart. “It is easier to get sick than it is to get better,” he explains.
Dr. Emran notes that anyone can get sepsis and that a lot of people downplay it, sometimes pushing it until it’s too late. Early intervention is key. He also explains that it will become more common as a lot of people have underlying chronic health conditions like diabetes, obesity, and COPD. In order to avoid life-threatening problems, Frankie encourages people to properly manage the underlying chronic conditions and to seek out their doctor as soon as they get sick.
Most importantly, people should maintain a healthy lifestyle to avoid chronic conditions in the first place, take vitamins, get exercise, and maintain healthy habits. “The shape you’re in, the better your body can fight infections.”
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