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From Sepsis to Shock: What Happens When Bacteria Invade the Body
Dr. Green is Clinical Research Fellow, Department of Emergency Medicine, University of California, Davis School of Medicine.
Severe sepsis is a common but deadly condition. It is usually caused by a bacterial infection that sets off a body-wide inflammatory response.(1)(2) It can show up in a number of ways. A patient might appear in the ER with an altered body temperature – typically higher than 100.4° F (38° C) or lower than 96.8° F (38° C), rapid heartbeat, rapid breathing, or lab tests showing signs of an infection (lots of white blood cells) or unusually few white cells.
The leading cause of death in U.S. hospitals, severe sepsis is associated with an estimated in-hospital mortality risk between 25 and 30%.(3) In the U.S. alone, more than 500,000 adult patients are admitted to hospitals every year with evidence of sepsis and organ dysfunction.(4) Each year in the United States there are approximately 750,000 cases of severe sepsis, which result in 215,000 deaths.(3)
Even more disturbing is the fact that the volume of patients presenting to hospitals with sepsis appears to be increasing, making it increasingly difficult for doctors to quickly identify these patients and determine how severe their sepsis is.(5)
Some relatively new techniques have shown a lot of promise in the treatment of severe sepsis. For example, Early Goal Directed Therapy (EGDT), which involves intense monitoring of oxygen delivery to the patient, can resuscitate patients and reduce the risk of mortality in people with dysfunctions of the heart or other organs.(6)(7)(8) The benefit of these newer methods decreases however, if there is any delay in beginning them, which makes it essential for doctors to determine which patients are at the highest risk and for patients and families to be alert to the symptoms.
Why Is Sepsis So Dangerous?
A person can develop sepsis when the body – in particular, the bloodstream – is overwhelmed with bacteria. The infection can begin anywhere in the body, but common places are the intestines, kidneys, lungs (as in pneumonia), or the linings around the brain (as in meningitis).(76)
If a patient is hospitalized for any reason, sepsis can develop from an IV line or at a surgical incision if he or she has had surgery.
Symptoms of severe infection typically include chills, fever, confusion, rash, and shaking. The most dangerous symptom of sepsis is a rapid drop in blood pressure, which can cause a patient to go into shock, which is life-threatening since the organs, including the brain, are deprived of oxygen. Treatment involves giving antibiotics through an IV, and administering fluids, oxygen, and medications to bring blood pressure back up. Sometimes a breathing machine or dialysis may be needed if the lungs or kidneys are affected.