As sepsis cases appear to be on the rise, this month we thought we would take a look at the illness and see if we can shed some light on the symptoms and what action to take. Throughout this blog we will show you when to call 999/112 as well as when to use the NHS 111 service.
History of the term Sepsis
Hippocrates first used the term ‘σήψις’ (sepsis) in the 4th century BC. He used it to mean the process of decay or decomposition of organic matter. Hippocrates was the first person to use the term, which has been used over many years, along with other terminology to describe the same thing.
Avicenna, the father of early modern medicine, during the 11th century used the term ‘blood rot’ to describe diseases linked to the severe purulent (the discharging of pus) process and it wasn’t until the 19th century that the term sepsis was used to describe severe systemic toxicity.
So, having explored the origins of the term sepsis the obvious question is What is Sepsis?
Sepsis, according to the dictionary, is ‘the presence in tissues of harmful bacteria and their toxins, typically through infection of a wound’. Further than this, sepsis is a rare life-threatening serious complication of an infection; without quick treatment sepsis can lead to multiple organ failure and death!
What does Septic Shock mean?
Septic shock is when your blood pressure drops to a dangerously low level.
Who is at risk of sepsis?
Typically, the people most at risk of sepsis are:
- Already in hospital with a serious injury,
- Very young or very old,
- Having had surgery or have wounds or injuries as a result of an accident, or
- With a medical condition or receiving treatment for a condition which weakens the immune system.
Before we look deeper into the causes of sepsis, it may be prudent to mention that there are around 123,000 cases of sepsis in the UK each year. According to a leading safety expert earlier this month, the number of deaths recorded as a result of sepsis have risen by a third in 2 years. In the year ending April 2017 there were 15,722 deaths where sepsis was the leading cause, either in hospital or within 30 days of discharge. Professor Sir Brian Jarman believes that staff shortages and overcrowding on wards are to blame. NHS England says that more conditions are being classed as sepsis than ever before.
Causes of Sepsis
The most common primary sources of infection in sepsis are the lungs, the abdomen and the urinary tract. Typically, 50% of all sepsis cases start as an infection in the lungs, with no definitive cause identified in a third to a half of all cases.
Sepsis can be caused by viral or fungal infections although bacterial infections are far more common.
What is the Difference between Septicaemia and Sepsis?
Sepsis is often referred to as either blood poisoning or septicaemia, however both of these terms generally refer to the invasion of bacteria into the bloodstream, which is not solely what sepsis does. Sepsis can affect multiple organs and tissue, not just the blood, and can be present without any blood poisoning or septicaemia.
Signs and Symptoms
So, what should we be looking for if we suspect sepsis; this will depend on the age of the casualty as follows:
Is the sepsis suspected casualty under 5 years old? If so:
Go straight to A&E or call 999/112 if the casualty:
- 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, the glass test will work,
- Has a seizure or a convulsion.
The NHS advises using the NHS 111 service should the child have any of the symptoms listed below, is getting worse or is sicker than you would expect; this is the case even if the child’s temperature falls. The signs and symptoms to be aware of are as follows and are split into different areas of concern.
You will need to check your child’s temperature and if their temperature reaches the following, you should call NHS 111 Service for advice:
- A child under 3 months has a temperature of over 38˚C,
- A child between 3 and 6 months has a temperature of over 39˚C,
- Any high temperature in a child who cannot be encouraged to show an interest in anything, or
- A child has a low temperature, below 36˚C, which you will need to check 3 times in a 10-minute period.
Is the child:
- Finding it much harder to breathe than normal, does it look like the child is working harder than normal to breathe?
- Making a grunting sound with each breath,
- Struggling to say more than a few words at once,
- Having obvious pauses in breathing.
You will need to consider whether the child has not had a wee or a wet nappy for 12 hours.
Eating and drinking concerns:
Should you experience the following, it is advised that you contact the NHS 111 service for advice, has the child:
- Who is under 1 month old got no interest in feeding?
- Not had a drink or shown interest in drinking for more than 8 waking hours,
- Got bile-stained (green coloured), bloody or black vomit.
Activity and Body concerns:
Carefully consider the following, has the child:
- Got a bulging soft spot on the top of their head,
- Eyes gone sunken or appear to be sunken,
- Lost interest in anything and cannot be encouraged to show any interest,
- Gone floppy,
- Gone weak,
- Got a whine or continuous crying in younger children,
- Become confused (older child),
- Started to be unresponsive or very irritable,
- Got a stiff neck, particularly when trying to look up or down.
We would highly recommend that parents trust their instincts and seek medical advice urgently from the NHS 111 service should they spot any of the symptoms listed above.
Early sepsis symptoms in children over 5 and adults:
The following signs and symptoms should be considered in children who are over 5 years old and/or adults:
- High temperature or a low body temperature,
- Chills and shivering,
- A fast heartbeat,
- Fast breathing.
In some cases, symptoms of more severe sepsis or septic shock develop soon after, these signs and symptoms include:
- Feeling dizzy and or faint,
- Nausea and vomiting,
- Slurred speech,
- Severe muscle pain,
- Severe breathlessness,
- Less urine production than normal, for example, not urinating for a day,
- Cold, clammy, pale or mottled skin,
- Change in mental state – which includes confusion or disorientation,
Signs and symptoms based on the NHS Choices website with thanks.
When should I get Medical Help?
Should you, or the person you are concerned about, have recently had an infection or injury and are showing the early signs of sepsis it is important that you seek medical advice urgently from the NHS 111 service. If the operator at the end of the telephone believes that sepsis is a possibility they will usually refer you to the hospital for further diagnosis and treatment.
Severe sepsis and septic shock ARE medical emergencies. If you believe that you or somebody in your care has one of these conditions it is vital you go straight to the A&E department or call 999/112.
For more information, you can visit the UK Sepsis Trust whose vision is to end preventable deaths from sepsis. They have a number of campaigns ongoing which you can view on their website:
In summary, the UK Sepsis Trust advises asking, ‘Could it be Sepsis?’ By asking this question with casualties who, as we discussed earlier, are at risk of sepsis you could save a life. We will leave this blog with the signs’ acronym that the UK Sepsis Trust has compiled for suspected sepsis in adults:
S Slurred speech or confusion
E Extreme shivering or muscle pain
P Passing no urine (in a day)
S Severe breathlessness
I It feels like you are going to die
S Skin mottled or discoloured.