Sepsis/septic shock

[kan...@aol.com]

This is me just emoting. Sorry. 

So sepsis is a condition where the body is affected by overwhelming infection. Back in the old days it implied that bacteria were actually in the bloodstream. But now it refers to a serious infection that overwhelms the bodies defenses, leading to multiple organ failure and death. Bacteria in the blood not always found. Not so many years ago, sepsis mortality easily exceeded 50%. It still kills lots of people, often abruptly. 

Sadly, one of my patients suffered this event yesterday. She came to clinic for a wound exam. She was clearly ill; my triage nurse picked up on it right away. She was literally shivering and teeth chattering. Her temp was 103.1. Sadly she refused a trip to the ER, despite our insistence. 

So how septic was she? She died on the way home. So at minute "0" she was talking, with decent blood pressure. At minute < 15 it was over. We're all pretty saddened. She was chronically ill, on dialysis; and we took care of multiple wounds over several years. She was a nice woman with a very supportive sister. 

Is there medical advice buried here? Well, if a person becomes suddenly ill, especially with fever, sepsis is on the menu. It could look a lot like the flu, with fever, chills, aches. Often the source isn't clear. It can be subtle in the elderly, often presenting as no more than a change in behavior/alertness. So pay attention to your parents/grandparents. 

People presenting to an ER with possible sepsis are supposed to be treated with the same urgency as a heart attack or stroke. Now we know why. Antibiotics within the first hour. Rapid fluid infusion. 

This is part of medicine. Thanks. 

[GMoney]

So if she'd gone to the ER, you think they could have saved her life??

Doesn't sound like she had a very good quality of life :/

Still very sad. Sorry for the loss. My good friend is a PICU nurse at children's mercy....most days she's ok...but there are some when she gets home and the losses are just too much. you can't feel them all, you'd go nuts, but some days you just can't help but take them home with you.

 

I dunno how doctors and nurses do it. 

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[B Keg]

Sorry that's got to be hard for you. 15 minutes later, wow.  Was there really anything anyone could have done?

Be nice, even when you don't want to!

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[kan...@aol.com]

Thanks G and BK. I always replay the scenario in my head with me being the hero doctor. Take her to the ER and stick around reliving my glory days as an ER doc. 

Yes, it's hard to have this happen. I've been around plenty of people who died; but this was a bit different. She was like 50 yards from where she belonged to have a chance. 

The main emotion is frustration. 

As for what would have happened, I think that she would have likely survived the stabilization process, but stayed really  ill for a long time. There is a good chance though that she might have perished in the next hour of care. I'd say 60/40, maybe 40/60. Sepsis protocol is pretty much newer than my time in the ER. Very aggressive attempts at reversing the catastrophe. 

Her quality of life was "meh". Dialysis patients don't love their plight. You have to fluid restrict to about 1.5 quarts per day. Any more doesn't get lost by breathing, sweating and pooping. And then they take off extra fluid at dialysis based on weight. So if you go in say 4-8 pounds over your dry weight, they'll take off 2-4 liters of fluid. That roughly the 4-8  pounds. So imagine going out when it's 95 degrees, working/playing and sweating off 2 quarts of fluid and then NOT drinking it back. You'd feel very shitty. Then do that 3 times a week. 

So dialysis sucks. Her wound condition was also somewhat sucky, having been chronic for several years. The wounds are a complication of her renal failure and are plenty painful. 

She was eligible for a transplant; but needed to be free of wounds before proceeding. 

After this happened her sister called to inform us and THANKED us for our years of compassionate care. Classy person. 

Being a caring provider team yields all kinds of good result. One is that when things for south people don't jump to immediately blame you. You also get better patient buy-in with participating in their care. 

Since I've done wound care I get a patient every couple of weeks that needs a trip to the ER. Hear attack in progress, pulmonary embolus, sepsis not quite so fatally ill. I thought I was over that shit; but they keep pulling me back in. (Sorry Pacino).