Sepsis and Septic Shock

Sepsis is serious medical emergency in which the body has an extreme and life-threatening reaction to an infection. Typically, when there is an infection in the body, the immune system will work to fight the infection. Sepsis occurs when this infection-fighting process turns on the body. The immune system stops fighting the infection, and starts damaging the body’s tissues and organs. This leads to an abnormal chain reaction in the clotting system which can cause blood clots to form in the blood vessels and can reduce blood flow to different organs. Sepsis causes a widespread inflammation throughout the body, and causes the organs to work poorly or, sometimes, not at all.

Sepsis can be separated into three stages: (1) sepsis, (2) severe sepsis, and (3) septic shock. Sepsis becomes “severe sepsis” once it has caused organs to malfunction – typically due to the low blood pressure caused by inflammation. Once blood pressure becomes extremely low and starts causing organ failure, the sepsis has progressed to “septic shock.”

All stages of sepsis are medical emergencies and can be life-threatening. However, as sepsis progresses into the other stages, the risk of death increases. Septic shock is the most dangerous and severe stage of sepsis and requires immediate medical treatment. Septic shock can cause death in as little as 12 hours if not treated promptly.

Symptoms

Sepsis can be caused by various types of infections and can affect many different areas of the body. Therefore, the symptoms of sepsis can vary and may be specific to the type of infection that caused it. For example, if sepsis was triggered by an infection in the blood, symptoms may include a red, discolored rash on the skin; possibly with small, dark-red spots visible. Other common symptoms of sepsis generally include the following:

• Fast heart rate
• Low blood pressure
• Fever or very low body temperature (hypothermia)
• Changes in mental status, confusion, or agitation
• Rapid, shallow breathing (hyperventilation) or shortness of breath
• Lightheadedness, weakness, or low energy
• Shaking or chills
• Sweating for no clear reason/warm or clammy skin
• Extreme pain or discomfort

When sepsis progresses to septic shock, it causes a severe drop in blood pressure and additional or worsening symptoms, such as:

• Major changes in mental status and extreme confusion
• Little or no urine output
• Heart palpitations
• Cool, pale limbs
• Skin rash
• Inability to stand up or stay awake

Causes

Sepsis can be caused by bacterial, fungal, viral, or parasitic infections. Although bacterial infections are one of the most common causes of sepsis, any type of infection can potentially lead to sepsis if it causes enough inflammation. The infections that can lead to sepsis can start anywhere in the body, but most commonly begin in the lungs, bladder, or stomach.

Infections that are more likely to cause sepsis include the following:

• Lung infections, such as pneumonia
• Urinary system infections, such as infections in the bladder or kidneys, especially at catheter sites
• Digestive or gastrointestinal system infections, such as appendicitis, peritonitis, bowel infections, or gallbladder or liver infections
• Infections of the bloodstream
• Infections of the brain or spinal cord
• Skin infections, typically due to bacteria entering the skin through wounds, burns, the openings made by catheters and IVs, or inflammation conditions such as cellulitis

Risk Factors

Over 1.7 million people in the United States are diagnosed with sepsis every year. Sepsis can affect anyone; however, it is more common among older adults, especially over the age of 65. Other factors that increase the risk that an infection will lead to sepsis include the following:

• Newborns, infants, and pregnant people
• People with a lower or weakened immune system response, such as those being treated for cancer or HIV; or a condition that requires treatment with corticosteroids which can lower immune response
• People with chronic diseases such as COPD, diabetes, obesity, or kidney disease
• Being in the hospital for medical reasons, especially longer hospital stays or admissions to the intensive care unit (ICU)
• Treatment with antibiotics in the last 90 days
• People with severe injuries, such as large burns or wounds
• People with catheters, IVs, breathing tubes, or other devices that go into the body

An episode of severe sepsis (or septic shock) raises the risk that a person may develop future infections. Most people recover from mild sepsis, but the mortality rate increases to about 30% to 40% in cases of septic shock. It is important to note that sepsis itself is not contagious, but the infections that cause sepsis can typically be spread to others.

Diagnosis

Medical providers typically use a combination of findings and tests to identify infection and diagnose sepsis. There is no strict criteria to diagnose sepsis, but quick identification of infections which may develop into sepsis is very important. A medical provider may order the following tests to help identify infections, sources of infections, and any organ damage or dysfunction:

Blood Tests:

Blood samples may be used to test for evidence of infection, blood-clotting problems, the level of oxygen in the blood, abnormal kidney or liver function, and electrolyte imbalances. Medical providers will typically order a complete blood count (CBC) and blood cultures.

Lab Tests:

Medical providers may take samples of other fluids, such as the following, to be tested in a lab in order to find the source of an infection:

• Urine (urinalysis and/or urine culture)
• Mucus and salvia samples from the respiratory tract
• Fluids from a specific wound

Imaging Tests:

Imaging tests may be ordered when the source of infection is not easily identified or to further assess potential infection of specific organs or areas inside the body. Examples of common imaging tests include:

• X-ray: Infections in the lungs can show up on x-ray images
• Ultrasound: Infections in the gallbladder and kidneys can be shown through an ultrasound
• CT Scan: Infections in the liver, pancreas, and other abdominal organs are easier to see on CT scans
• MRI: MRIs may be helpful for seeing infections in soft tissue or the bones

At bedside during a hospital admission, a medical provider may use a tool called “quick sequential organ failure assessment” (qSOFA) to assess a suspicion of sepsis as well. Essentially, sepsis is suspected if the patient has confirmed or probable infection and at least two of the following criteria:

• Low blood pressure
• High respiratory rate
• A score of 15 or less on the Glasgow coma scale

Treatment

The most important concern in sepsis protocol is a quick diagnosis and prompt treatment. Thorough treatment for sepsis must begin immediately in order to give a patient the best chance at recovery. Treatment involves close monitoring and care, typically in a hospital’s intensive care unit. Lifesaving measures to stabilize breathing and heart action may be needed and treatment with antibiotics and IV fluids should begin as soon as possible. Treatments for sepsis include the following:

• Antibiotics: Broad-spectrum antibiotics (effective against a variety of bacteria) are typically used first until blood cultures come back identifying the germ causing the infection. Once the blood cultures come back and the specific infection is identified, the broad-spectrum antibiotic may be switched out for an antimicrobial that targets the specific germ causing the infection.
• Vasopressors: If blood pressure is too low, even after receiving IV fluids, vasopressors may be used to narrow the blood vessels and increase blood pressure.
• Medications: Depending on the circumstances, other medications may also be used, such as painkillers, or insulin for blood sugar levels.
• Supportive Care: Supportive care is often needed in sepsis patients with organ damage or organ failure and can include oxygen, ventilators, dialysis, or other treatments depending on the organs affected.
• Surgery: Surgery is sometimes needed to remove sources of infection, such as pus and infected or dead tissue.

Complications

Although many people recover from sepsis completely with prompt treatment, others may experience long-term effects and complications, such as:

• Organ failure
• Decreased cognitive functioning (decision making abilities, learning, concentrating, remembering)
• Joint and muscle pain
• Insomnia
• Nightmares or hallucinations
• Panic attacks

Complications of septic shock, specifically, can include the following:

• Brain damage
• Lung, heart, or kidney failure
• Gangrene
• Death

It is important to remember that people who have survived sepsis are at a higher risk of developing sepsis again. Sepsis is extremely hard on the body, even when caught early. Most people undergo rehabilitation after surviving sepsis to restore their health. The body and mind will need time to recover after sepsis before they begin to feel back to normal.

Filing a Medical Malpractice Claim or Lawsuit

If you or a family member has suffered complications from sepsis or septic shock that was negligently diagnosed or treated, you may be entitled to compensation for your damages. Call Bonner Law at 1-800-4MEDMAL or visit our pagefor a free consultation.

Medical malpractice cases are complex and can be emotionally challenging for the patients involved. Finding the right attorney can make the process much easier. Michael P. Bonner has over 30 years of experience representing patients in medical malpractice cases all over Florida. Bonner Law has the knowledge and experience to represent you and navigate the legal and medical landscape to ensure that you receive compensation for damages, including medical bills, lost wages, and pain and suffering that you are entitled to. For more information on medical malpractice claims you can also visit our Medical Malpractice page.