Sepsis

Leave a comment Posted on Blood

Sepsis – what are the signs and symptoms of the unknown killer?

Sepsis - blood poisoning

Sepsis – blood poisoning

 

Sepsis is a rare but serious complication of an infection.

Without quick treatment, sepsis can lead to multiple organ failure and death.

 

Sepsis symptoms in children under five

Go straight to A&E or call 999 if your child has any of these symptoms:

looks mottled, bluish or pale

is very lethargic or difficult to wake

feels abnormally cold to touch

is breathing very fast

has a rash that does not fade when you press it

has a fit or convulsion

Get medical advice urgently from NHS 111

If your child has any of the symptoms listed below, is getting worse or is sicker than you’d expect (even if their temperature falls), trust your instincts and seek medical advice urgently from NHS 111.

Temperature

temperature over 38C in babies under three months

temperature over 39C in babies aged three to six months

any high temperature in a child who cannot be encouraged to show interest in anything

low temperature (below 36C – check three times in a 10-minute period)

Breathing

finding it much harder to breathe than normal – looks like hard work

making “grunting” noises with every breath

can’t say more than a few words at once (for older children who normally talk)

breathing that obviously “pauses”

Toilet/nappies

not had a wee or wet nappy for 12 hours

Eating and drinking

new baby under one month old with no interest in feeding

not drinking for more than eight hours (when awake)

bile-stained (green), bloody or black vomit/sick

Activity and body

soft spot on a baby’s head is bulging

eyes look “sunken”

child cannot be encouraged to show interest in anything

baby is floppy

weak, “whining” or continuous crying in a younger child

older child who’s confused

not responding or very irritable

stiff neck, especially when trying to look up and down

If your child has any of these symptoms, is getting worse or is sicker than you’d expect (even if their temperature falls), trust your instincts and seek medical advice urgently from NHS 111.

Sepsis symptoms in older children and adults

Early symptoms of sepsis may include:

a high temperature (fever) or low body temperature

chills and shivering

a fast heartbeat

fast breathing

In some cases, symptoms of more severe sepsis or septic shock (when your blood pressure drops to a dangerously low level) develop soon after.

These can include:

feeling dizzy or faint

a change in mental state – such as confusion or disorientation

diarrhoea

nausea and vomiting

slurred speech

severe muscle pain

severe breathlessness

less urine production than normal – for example, not urinating for a day

cold, clammy and pale or mottled skin

loss of consciousness

When to get medical help

Seek medical advice urgently from NHS 111 if you’ve recently had an infection or injury and you have possible early signs of sepsis.

If sepsis is suspected, you’ll usually be referred to hospital for further diagnosis and treatment.

Severe sepsis and septic shock are medical emergencies. If you think you or someone in your care has one of these conditions, go straight to A&E or call 999.

Tests to diagnose sepsis

Sepsis is often diagnosed based on simple measurements such as your temperature, heart rate and breathing rate. You may need to give a blood test.

Other tests can help determine the type of infection, where it’s located and which body functions have been affected. These include:

urine or stool samples

a wound culture – where a small sample of tissue, skin or fluid is taken from the affected area for testing

respiratory secretion testing – taking a sample of saliva, phlegm or mucus

blood pressure tests

imaging studies – such as an X-ray, ultrasound scan or computerised tomography (CT) scan

Treatments for sepsis

If sepsis is detected early and hasn’t affected vital organs yet, it may be possible to treat the infection at home with antibiotics. Most people who have sepsis detected at this stage make a full recovery.

Almost all people with severe sepsis and septic shock require admission to hospital. Some people may require admission to an intensive care unit (ICU).

Because of problems with vital organs, people with severe sepsis are likely to be very ill and the condition can be fatal.

However, sepsis is treatable if it is identified and treated quickly, and in most cases leads to a full recovery with no lasting problems.

Read more about treating sepsis.

Recovering from sepsis

Some people make a full recovery fairly quickly. The amount of time it takes to fully recover from sepsis varies, depending on:

the severity of the sepsis

the person’s overall health

how much time was spent in hospital

whether treatment was needed in an ICU

Some people experience long-term physical and/or psychological problems during their recovery period, such as:

feeling lethargic or excessively tired

muscle weakness

swollen limbs or joint pain

chest pain or breathlessness

These long-term problems are known as post-sepsis syndrome. Not everyone experiences these problems.

Read more about recovering from sepsis on the UK Sepsis Trust website.

Who’s at risk?

There are around 123,000 cases of sepsis a year in England. Around 37,000 people die every year as a result of the condition.

Anyone can develop sepsis after an injury or minor infection, although some people are more vulnerable.

People most at risk of sepsis include those:

with a medical condition or receiving medical treatment that weakens their immune system

who are already in hospital with a serious illness

who are very young or very old

who have just had surgery or who have wounds or injuries as a result of an accident

Read more about the causes of sepsis.

Leave a comment Posted on Blood

World Sepsis Day – Tuesday 13 September – What are the signs and symptoms of sepsis?

World Sepsis Day 2016

World Sepsis Day 2016

What are the signs and treatment of sepsis?

“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.

Leave a comment Posted on A to Z of Medical Conditions

Acute respiratory distress syndrome – what are the signs and symptoms of ARDS

Breathing difficulty

Acute respiratory distress syndrome

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
feeling faint

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
near drowning
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

Treating ARDS

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.

 

[Original article on NHS Choices website]

Leave a comment Posted on A to Z of Medical Conditions

Acute cholecystitis – find out more about the signs and symptoms of swelling of the gallbladder.

Acute cholecystitis

Acute cholecystitis

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
  • sweating
  • 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

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

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.

Acalculous cholecystitis is often associated with problems such as accidental damage to the gallbladder during major surgery, serious injuries or burns, blood poisoning (sepsis), severe malnutrition or AIDS.

Who is affected

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.

Diagnosing cholecystitis

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

Other scans – such as an X-ray, a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan – may also be carried out to examine your gallbladder in more detail if there is any uncertainty about your diagnosis.

Treating acute cholecystitis

If you are diagnosed with acute cholecystitis, you will probably need to be admitted to hospital for treatment.

Initial 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.

Surgery

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.

Read more about recovering from gallbladder removal.

Possible complications

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.

Read more about preventing gallstones.

[Original article on NHS Choices website]

Leave a comment Posted on Blood

Sepsis Awareness Month – find out about the medical condition which causes the deaths of over 250,000 Americans each year.


Sepsis Awareness

Sepsis Awareness

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.