Recognizing, Treating Septic Shock

"Watch for a combination of these symptoms [chills or fever, high heart rate, shortness of breath; possibly extreme pain or discomfort, clammy or sweaty skin, signs of confusion or disorientation]."
"If you suspect sepsis, call 911 or go to a hospital and say, 'I am concerned about sepsis'."
Sepsis Alliance, awareness campaign

"Sepsis masquerades as many other conditions, often resulting in a delayed recognition of the serious infection until the patient falls critically ill."
Dr. Tamara McColl, lead author, sepsis study

Close up of syringe vial and pills on Septicemia text alexskopje / Getty Images/iStockphoto

The condition known as sepsis, a potentially life-threatening situation resulting from the body's immune system's response to a serious infection, kills over 9,000 people a year in Canada. And the reason that so many people die of sepsis is that it is frequently difficult to recognize for what it is; a medical emergency. Sepsis causes death for more people than do strokes, heart attacks or car accidents, but its virulent presence and the consequence of its presence often fails to alert medical personnel adequately to arrest its deadly progress in its early stages.

The body's immune system mounts a toxic, overwhelming response at times to an invasive infection. Infectious agents like bacteria, viruses, fungi or parasites sometimes trigger such a comprehensive and deep reaction that sepsis sets in. Most of these instances are initiated when people are at home, which has led the U.S.-based charity, Sepsis Alliance to launch a campaign hoping to help people recognize the symptoms, and act on them by going immediately to an hospital emergency department and declaring their suspicions.

A new study published in the Canadian Journal of Emergency Medicine indicates that the potentially life-threatening condition responds well to a simple, low-cost program to apprehend the direction of sepsis. Put into place at The Ottawa Hospital, the new program has succeeded in reducing the mortality rate among severe sepsis patients by 13 percent, saving roughly 50 lives each year. Sepsis commonly affects people over the age of 65, but young children and those people with a compromised immune system are equally at risk.

The new protocol introduced at The Ottawa Hospital's two emergency departments, termed "sepsis bundle", was the focus of the study whose idea was to treat sepsis patients with the kind of "aggressive mindset" that takes place among emergency personnel when they are faced with the presentation of life-threatening critical conditions. The need for medical staff to swiftly identify sepsis cases and to respond with the delivery of treatments such as intravenous fluids and antibiotics before advancement to a critical stage was seen as paramount to forestalling disaster.

An internal review had been undertaken in the hospital, after discovery that the sepsis protocol that had been introduced in 2008 was simply not working as well as it was intended to. A new redesigned protocol mounted by a hospital committee relating to patient management and physician consultation, bedside nurses, triage nurses and managers, was put in place. Measures to flag potential sepsis cases on medical charts and departmental white boards ensures that flagged patients are closely monitored in designated beds.

The nurses have the capacity under the new protocol to initiate IV without seeking the approval of a doctor. Nurses have been tasked with reminding doctors of the need to treat any sepsis cases within one hour of arrival at the emergency department. An extensive education campaign featuring posters, pocket cards, group presentations and luncheons was embarked upon in 2013. The condition affects an estimated 40,000 to 50,000 Canadians each year, a not-insignificant number.

Dr. McColl, formerly an emergency medicine resident at The Ottawa Hospital, and now an emergency physician in Winnipeg, studied two sepsis patient cohorts with her colleagues. The cohort treated in the 5 months preceding the new protocol and those treated post-introduction presented with similar underlying medical conditions. A significant drop in the 30-day mortality rate among sepsis patients from 30.7 percent under the old protocol to 17.3 percent with the new was documented by the researchers.

Analysis revealed that patients in the second, post-introduction of the new protocol, were treated in a "notably shorter" time than those in the first group, a finding which related to fewer sepsis patients requiring invasive treatments, or subsequent admission to intensive care.