“The figures are huge” says John Parker who is Leicester’s Hospitals Sepsis Lead Consultant , “every year in the UK there are 150,000 cases of Sepsis, resulting in a staggering 44,000 deaths – more than bowel, breast and prostate cancer combined. Unfortunately the initial signs are often ignored, an individual may say “I just felt like I had a bout of flu, stomach upset or chest infection” and so people don’t get any medical attention. Early diagnosis is essential, so we want to highlight the signs of Sepsis and raise its awareness.”
“It’s important to remember that sepsis is a medical emergency. Every minute and hour counts, especially since the infection can spread quickly. There’s no one symptom of sepsis, but rather it has a combination of symptoms.”
Sepsis is caused by the way the body responds to germs, such as bacteria, getting into your body. The infection may have started anywhere in a sufferer’s body, and may be only in one part of the body or it may be widespread. Sepsis can occur following chest or water infections, problems in the abdomen like burst ulcers, or simple skin injuries like cuts and bites.
“A lot of people will more readily know sepsis as septicaemia or blood poisoning and whilst diagnosis and treatment can be different for adult and children, the basic signs to look out for are:
S lurred speech
E xtreme shivering or muscle pain
P assing no urine (in a day)
S evere breathlessness
I feel like I might die
S kin mottled or discoloured
Amandeep Sadhra who has recovered from sepsis says “I was just going about my normal day, when I noticed a rash on my hand, I didn’t really take any notice of it as I suffer from eczema, but during the course of the day it got worse and was throbbing a lot. By the time I got home after work, I felt very tired and had no appetite. I decided to just take some paracetamol and go to bed. The next day I felt no better and didn’t want to get up and my hand had ballooned up like a boxing glove and I was starting to shiver, I felt like I was getting a fever. It was at this time my husband said we should go to the Emergency Department.
“I received scans, a blood test and was advised that as there was a lot of fluid on my hand that I would have to have an operation, but during the course of the night the doctor advised me that my blood pressure was dropping and the antibiotics were not working and I was going to be transferred to intensive care. The next day I was taken for my operation and woke up five or so days later after my procedure. I was then advised that I had been very ill after my operation, suffering from multiple organ failure, slight pneumonia and it was decided to continue my sedation. I was then advised that I had Sepsis.”
“It was a life-changing event, I had always been fit and healthy but after being discharged from hospital it has taken me several months to recuperate, go back to work, get back to normal. You never think something like this could happen to you, particularly from something so minimal like a skin rash to something life threatening.”
If you suspect sepsis, get medical attention immediately.
Acute respiratory distress syndrome (ARDS) is a life-threatening medical condition where the lungs can’t provide enough oxygen for the rest of the body.
ARDS can affect people of any age and usually develops as a complication of a serious existing health condition. Consequently, most people have already been admitted to hospital by the time the symptoms of ARDS begin.
Symptoms of ARDS can include:
severe shortness of breath
rapid, shallow breathing
tiredness, drowsiness or confusion
Although most cases of ARDS begin in hospital, this isn’t always the case. For example, the condition may develop quickly as a result of an infection such as pneumonia, or if someone accidentally inhales their vomit.
Dial 999 immediately to request an ambulance if you notice any breathing problems in a child or adult.
What causes ARDS?
ARDS develops if the lungs become severely inflamed as a result of an infection or injury. The inflammation causes fluid from nearby blood vessels to leak into the tiny air sacs in your lungs, making breathing increasingly difficult.
The lungs may become inflamed following:
pneumonia or severe flu
blood poisoning (sepsis)
a severe chest injury
accidental inhalation of vomit, smoke or toxic chemicals
acute pancreatitis – a serious condition where the pancreas becomes inflamed over a short period of time
an adverse reaction to a blood transfusion
How ARDS is diagnosed
There’s no specific test to diagnose ARDS. A full assessment is needed to identify the underlying cause and rule out other conditions. This assessment is likely to include:
a physical examination
blood tests – to measure the amount of oxygen in the blood and check for an infection
a pulse oximetry test – where a sensor attached to the fingertip, ear or toe is used to measure how much oxygen the blood is absorbing
a chest X-ray and a computerised tomography (CT) scan – to look for evidence of ARDS
an echocardiogram – a type of ultrasound scan used to create a picture of the heart
If someone develops ARDS, they’ll probably be admitted to an intensive care unit (ICU) and put on a ventilator to assist their breathing.
In some cases, it may be possible to use an oxygen mask to supply oxygen. However, in severe cases of ARDS, a tube will need to be inserted down the throat and into the lungs to allow oxygen to be pumped in.
Fluids and nutrients will be supplied through a tube that goes into the stomach through the nose. Read more about feeding tubes.
The underlying cause of ARDS should also be treated. For example, if it’s caused by a bacterial infection, antibiotics may need to be prescribed to help fight the infection.
The amount of time you need to spend in hospital will depend on your individual circumstances and the cause of ARDS. Most people respond well to treatment within days, but it may be several weeks or months before someone with ARDS is well enough to leave hospital.
Complications of ARDS
As ARDS is often caused by a serious health condition, about one in three people who develop it will die. However, most deaths result from another problem caused by their illness, rather than ARDS itself.
For people who survive, the main complications are associated with nerve and muscle damage, which causes pain and weakness. Some people also develop psychological problems, such as post-traumatic stress disorder (PTSD) and depression. The lungs themselves usually recover and long-term (chronic) lung failure after ARDS is rare.
Acute cholecystitis is swelling (inflammation) of the gallbladder. It is a potentially serious condition that usually needs to be treated in hospital.
The main symptom of acute cholecystitis is a sudden sharp pain in the upper right side of your tummy (abdomen) that spreads towards your right shoulder.
The affected part of the abdomen is usually extremely tender, and breathing deeply can make the pain worse.
Unlike some others types of abdominal pain, the pain associated with acute cholecystitis is usually persistent, and doesn’t go away within a few hours.
Some people may additional symptoms, such as:
a high temperature (fever)
nausea and vomiting
loss of appetite
yellowing of the skin and the whites of the eyes (jaundice)
a bulge in the abdomen
When to seek medical advice
You should see your GP as soon as possible if you develop sudden and severe abdominal pain, particularly if the pain lasts longer than a few hours or is accompanied by other symptoms, such as jaundice and a fever.
If it’s not possible to contact your GP immediately, phone your local out-of-hours service or call NHS 111 for advice.
It’s important for acute cholecystitis to be diagnosed as soon as possible, because there is a risk that serious complications could develop if the condition is not treated promptly (see below).
What causes acute cholecystitis?
The causes of acute cholecystitis can be grouped into two main categories: calculous cholecystitis and acalculous cholecystitis.
Calculous cholecystitis is the most common, and usually less serious, type of acute cholecystitis. It accounts for around 95% of all cases.
Calculous cholecystitis develops when the main opening to the gallbladder, called the cystic duct, gets blocked by a gallstone or by a substance known as biliary sludge.
Biliary sludge is a mixture of bile (a liquid produced by the liver that helps digest fats) and small crystals of cholesterol and salt.
The blockage in the cystic duct results in a build-up of bile in the gallbladder, increasing the pressure inside it and causing it to become inflamed. In around one in every five cases, the inflamed gallbladder also becomes infected by bacteria.
Acalculous cholecystitis is a less common, but usually more serious, type of acute cholecystitis. It usually develops as a complication of a serious illness, infection or injury that damages the gallbladder.
Acute cholecystitis is a relatively common complication of gallstones.
It is estimated that around 10-15% of adults in the UK have gallstones. These don’t usually cause any symptoms, but in a small proportion of people they can cause infrequent episodes of pain (known as biliary colic) or acute cholecystitis.
In England, around 28,000 cases of cholecystitis were reported during 2012-13.
To diagnose acute cholecystitis, your GP will examine your abdomen.
They will probably carry out a simple test called Murphy’s sign. You will be asked to breathe in deeply with your GP’s hand pressed on your tummy, just below your rib cage.
Your gallbladder will move downwards as your breathe in and, if you have cholecystitis, you will experience sudden pain as your gallbladder reaches your doctor’s hand.
If your symptoms suggest you have acute cholecystitis, your GP will refer you to hospital immediately for further tests and treatment.
Tests you may have in hospital include:
blood tests to check for signs of inflammation in your body
an ultrasound scan of your abdomen to check for gallstones or other signs of a problem with your gallbladder
If you are diagnosed with acute cholecystitis, you will probably need to be admitted to hospital for treatment.
Initial treatment will usually involve:
fasting (not eating or drinking) to take the strain off your gallbladder
receiving fluids through a drip directly into a vein (intravenously) to prevent dehydration
taking medication to relieve your pain
If you have a suspected infection, you will also be given antibiotics. These often need to be continued for up to a week, during which time you may need to stay in hospital or you may be able to go home.
With this initial treatment, any gallstones that may have caused the condition usually fall back into the gallbladder and the inflammation often settles down.
In order to prevent acute cholecystitis recurring, and reduce your risk of developing potentially serious complications, the removal of your gallbladder will often be recommended at some point after the initial treatment. This type of surgery is known as a cholecystectomy.
Although uncommon, an alternative procedure called a percutaneous cholecystostomy may be carried out if you are too unwell to have surgery. This is where a needle is inserted through your abdomen to drain away the fluid that has built up in the gallbladder.
If you are fit enough to have surgery, your doctors will need to decide when the best time to remove your gallbladder may be. In some cases, you may need to have surgery immediately or in the next day or two, while in other cases you may be advised to wait for the inflammation to fully resolve over the next few weeks.
Surgery can be carried out in two main ways:
laparoscopic cholecystectomy – a type of keyhole surgery where the gallbladder is removed using special surgical instruments inserted through a number of small cuts (incisions) in your abdomen
open cholecystectomy – where the gallbladder is removed through a single, larger incision in your abdomen
Although some people who have had their gallbladder removed have reported symptoms of bloating and diarrhoea after eating certain foods, you can lead a perfectly normal life without a gallbladder.
The organ can be useful but it’s not essential, as your liver will still produce bile to digest food.
Without appropriate treatment, acute cholecystitis can sometimes lead to potentially life-threatening complications.
The main complications of acute cholecystitis are:
the death of the tissue of the gallbladder, called gangrenous cholecystitis, which can cause a serious infection that could spread throughout the body
the gallbladder splitting open, known as a perforated gallbladder, which can spread the infection within your abdomen (peritonitis) or lead to a build-up of pus (abscess)
In about one in every five cases of acute cholecystitis, emergency surgery to remove the gallbladder is needed to treat these complications.
Preventing acute cholecystitis
It’s not always possible to prevent acute cholecystitis, but you can reduce your risk of developing the condition by cutting your risk of gallstones.
One of the main steps you can take to help lower your chances of developing gallstones is adopting a healthy, balanced diet and reducing the number of high-cholesterol foods you eat, as cholesterol is thought to contribute to the formation of gallstones.
Being overweight, particularly being obese, also increases your risk of developing gallstones. You should therefore control your weight by eating a healthy diet and exercising regularly.
However, low-calorie, rapid weight loss diets should be avoided, because there is evidence they can disrupt your bile chemistry and actually increase your risk of developing gallstones. A more gradual weight loss plan is best.
September is, as you may know, Sepsis Awareness Month. I try to highlight the condition each year as it is nearly two years since my father in law nearly died from it.
The Sepsis Alliance in the UK are marking the month by an extensive awareness camplaign with some great food for thought!
“How can a small dog’s nip on the hand or a bug bite result in a battle to stay alive? How does someone go from the happiest day of her life, delivering her child, to being in an intensive care unit on a ventilator – with her family not knowing if she will live or die? How can someone who successfully undergoes a bone marrow transplant to beat cancer die because he got an infection?
These people all had something in common: they developed sepsis, an illness that fewer than half of Americans have ever heard of, yet every two minutes, another person in the country dies of it.
Sepsis is expensive for its victims and for society. It costs more than $17 billion per year to treat sepsis in hospitals in the U.S. The burden in lost income and expenses after initial sepsis treatment isn’t known.
Financial issues post sepsis can range from the inability to continue working in previous jobs to needing long-term care. Cost to the government and tax-payers? Fifty-eight percent of sepsis admissions had Medicare as the primary payer versus 36% for other hospitalizations.”
To find out more about signs, symptoms and treatments for sepsis check out our blog post here.
Child mortality rates have plummeted to less than half of what they were in 1990,
according to a new report released today. Under-five deaths have dropped from 12.7 million per year in 1990 to 5.9 million in 2015. This is the first year the figure has gone below the 6 million mark.
New estimates in Levels and Trends in Child Mortality Report 2015 released by UNICEF, the World Health Organization, the World Bank Group, and the Population Division of UNDESA, indicate that although the global progress has been substantial, 16,000 children under five still die every day. And the 53 per cent drop in under-five mortality is not enough to meet the Millennium Development Goal of a two-thirds reduction between 1990 and 2015.
“We have to acknowledge tremendous global progress, especially since 2000 when many countries have tripled the rate of reduction of under-five mortality,” said UNICEF Deputy Executive Director Geeta Rao Gupta. “But the far too large number of children still dying from preventable causes before their fifth birthday – and indeed within their first month of life – should impel us to redouble our efforts to do what we know needs to be done. We cannot continue to fail them.”
The report notes that the biggest challenge remains in the period at or around birth. A massive 45 per cent of under-five deaths occur in the neonatal period – the first 28 days of life. Prematurity, pneumonia, complications during labour and delivery, diarrhoea, sepsis, and malaria are leading causes of deaths of children under 5 years old. Nearly half of all under-five deaths are associated with undernutrition.
However, most child deaths are easily preventable by proven and readily available interventions. The rate of reduction of child mortality can speed up considerably by concentrating on regions with the highest levels – sub-Saharan Africa and Southern Asia – and ensuring a targeted focus on newborns.
“We know how to prevent unnecessary newborn mortality. Quality care around the time of childbirth including simple affordable steps like ensuring early skin-to-skin contact, exclusive breastfeeding and extra care for small and sick babies can save thousands of lives every year,” noted Dr Flavia Bustreo, Assistant Director General at WHO. “The Global Strategy for Women’s, Children’s and Adolescents’ Health, to be launched at the UN General Assembly this month, will be a major catalyst for giving all newborns the best chance at a healthy start in life.”
The report highlights that a child’s chance of survival is still vastly different based on where he or she is born. Sub-Saharan Africa has the highest under-five mortality rate in the world with 1 child in 12 dying before his or her fifth birthday – more than 12 times higher than the 1 in 147 average in high-income countries. In 2000-2015, the region has overall accelerated its annual rate of reduction of under-five mortality to about two and a half times what it was in 1990-2000. Despite low incomes, Eritrea, Ethiopia, Liberia, Madagascar, Malawi, Mozambique, Niger, Rwanda, Uganda, and Tanzania have all met the MDG target.
Sub-Saharan Africa as a whole, however, continues to confront the immense challenge of a burgeoning under-five population – projected to increase by almost 30 per cent in the next 15 years – coupled with persistent poverty in many countries.
“This new report confirms a key finding of the 2015 Revision of the World Population Prospects on the remarkable decline in child mortality globally during the 15-year MDG era,” said UN Under-Secretary-General for Economic and Social Affairs Mr. Wu Hongbo. “Rapid improvements since 2000 have saved the lives of millions of children. However, this progress will need to continue and even accelerate further, especially in high-mortality countries of sub-Saharan Africa, if we are to reach the proposed child survival target of the 2030 Agenda for Sustainable Development.”
“Many countries have made extraordinary progress in cutting their child mortality rates. However, we still have much to do before 2030 to ensure that all women and children have access to the care they need,” said Dr Tim Evans, Senior Director of Health, Nutrition and Population at the World Bank Group. “The recently launched Global Financing Facility in Support of Every Woman Every Child with its focus on smarter, scaled and sustainable financing will help countries deliver essential health services and accelerate reductions in child mortality.”
Among the report’s findings:
Roughly one-third of the world’s countries – 62 in all – have actually met the MDG target to reduce under-five mortality by two-thirds, while another 74 have reduced rates by at least half.
The world as a whole has been accelerating progress in reducing under-five mortality – its annual rate of reduction increased from 1.8 per cent in 1990-2000 to 3.9 per cent in 2000-2015.
10 of the 12 low income countries which have reduced under-five mortality rates by at least two-thirds are in Africa.
5 in 10 global under-five deaths occur in sub-Saharan Africa and another 3 in 10 occur in Southern Asia.
45 per cent of all under-five deaths happen during the first 28 days of life. 1 million neonatal deaths occur on the day of birth, and close to 2 million children die in the first week of life.