Nursing Home Residents At Risk
Every year, 25,000 nursing home residents die after being transferred to the hospital suffering from sepsis, a Chicago Tribune/Kaiser Health News investigation revealed as published by the Advisory Board .
The investigation went on to report that the majority of nursing homes in the U.S. fail to prevent bedsores and other infections that lead to sepsis. In fact, 72% of nursing homes across the country have received citations for not actively engaging in an effective infection-control program, according to the Advisory Boards report.
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How Should This Patient Be Managed
She should receive oxygen by face mask, or if her work of breathing is markedly increased, non-invasive ventilation may be considered. Peripheral intravenous access should be obtained, with consideration of intra-osseous needle insertion if peripheral venous access is not achieved rapidly. Fluid resuscitation should begin with a bolus of 10-20 mL/kg of balanced/buffered crystalloid solution, given over 5 to 20 minutes. Vital signs and peripheral perfusion should be monitored closely to evaluate the response to treatment, including potential fluid overload. Hepatomegaly or crackles on auscultation may suggest fluid overload. The bolus may be repeated depending on patient response, with frequent re-assessment . Clinical deterioration after bolus fluid administration, particularly in the presence of signs of volume overload, suggests the presence of cardiogenic shock . Other useful parameters include urine output, blood gases to assess presence of metabolic acidosis, serum lactate, bedside glucose, serum electrolytes, urea, and creatinine.
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Causes Of Sepsis And Septic Shock
They can cause the blood vessels to widen , decreasing blood pressure.
They can cause blood to clot in tiny blood vessels inside organs.
Most often, sepsis is caused by infection with certain kinds of bacteria that are usually acquired in a hospital. Rarely, fungi, such as Candida, cause sepsis. Infections that can lead to sepsis begin most commonly in the lungs, abdomen, or urinary tract. In most people, these infections do not lead to sepsis. However, sometimes bacteria spread into the bloodstream , dental or medical procedures, or from infections … read more ). Sepsis may then develop. If the initial infection involves an abscess, the risk of bacteremia and sepsis is increased. Occasionally, such as in toxic shock syndrome Toxic Shock Syndrome Toxic shock syndrome is a group of rapidly progressive and severe symptoms that include fever, rash, dangerously low blood pressure, and failure of several organs. It is caused by toxins produced… read more , sepsis is triggered by toxins released by bacteria that have not spread into the bloodstream.
How Is Sepsis Diagnosed
The diagnose sepsis, your healthcare provider will look for a variety of physical finding such as low blood pressure, fever, increased heart rate, and increased breathing rate. Your provider will also do a variety of lab tests that check for signs of infection and organ damage. Since some sepsis symptoms can often be seen in other conditions, sepsis can be hard to diagnose in its initial stages.
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How Can I Prevent Sepsis
One of the most important infection control behaviors is hand washing. You should wash hands with clean, running water for at least 20 seconds. Wash your hands:
Before and after caring for a sick person
Before, during, and after preparing food
Before and after cleaning a wound or cut
After blowing your nose, coughing, or sneezing
After touching an animal or handling pet food or pet treats
After changing diapers or cleaning up after a child who has used the toilet
After touching garbage
What Are The Signs Of Double Pneumonia
Pneumonia is an infection of one or both sides of the lungs that causes the air sacs to fill up with fluid or pus, according to the National Heart, Lung, and Blood Institute . Pneumonia can be caused by a bacteria, virus, or fungus. Symptoms can vary, but may include the following:
- Nausea, vomiting, or diarrhea
You can also develop complications of pneumonia, like septic shock, lung abscesses, renal failure, and respiratory failure, per the NHLBI.
Double pneumonia isnt an official medical term, but it usually refers to having pneumonia in both lungs, says Richard Watkins, M.D., an infectious disease physician and professor of internal medicine at Northeast Ohio Medical University.
It isnt necessarily more or less common than pneumonia that involves one lung, but it usually depends on the type of pneumonia a person has. Bacterial pneumonia more commonly involves one lung and viral often is a diffuse pattern in both lungs, Dr. Watkins says. X-rays and CT scans in patients with COVID-19 usually show both lungs are involved.
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How Serious Is Double Pneumonia
Pneumonia in any form is usually more serious for children under the age of five, adults over the age of 65, people with certain conditions like heart failure, diabetes, or chronic obstructive pulmonary disease , or people who have weakened immune systems, the NHLBI says.
Typically, double pneumonia is more serious for anyone, says Raymond Casciari, M.D., a pulmonologist at St. Joseph Hospital in Orange, Calif. If you have one good lung, it can meet all of your bodys needs until your other lung recovers. But, if both lungs are involved, youre in a fragile situation, he explains.
That said, it depends on the person and how their body reacts. One small area of the lungs thats affected by pneumonia can be life-threatening if its extensive, says Reynold Panettieri, M.D., a lung specialist and vice chancellor for translational medicine and science at Rutgers University. Sometimes, double pneumonia is well tolerated.
Healthcare Costs And Rationing Of Resources
There are huge financial implications in the management of sepsis on limited healthcare resources. Data suggests that the annual cost of sepsis management was $17 billion in the year 2000 alone. Moreover, more than half of this cost was attributable to the care of patients more than 65 years, and around one third to the care of patients more than 75 years of age. The frequency of sepsis is predicted to increase by more than 5% per year along with an increasing elderly population and higher mortality. Hence, management of sepsis in the elderly will have huge financial implications.
This has led to an intense debate on the rationing of resources, criteria for admission to the ICU and the decision to withdraw or withhold treatment in elderly patients. Denying ICU admission to the elderly has few supporters, however, denying ICU admission and inadequate treatment solely on age is highly controversial. There is enough evidence available on the association between increased intensity of treatment and improved survival and good long-term outcome even in the elderly. Hence, age only should not be the reason for denying admission or the appropriate management of sepsis in an elderly patient.
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What Are The Complications Of Pneumonia
Most people with pneumonia respond well to treatment, but pneumonia can be very serious and even deadly.
You are more likely to have complications if you are an older adult, a very young child, have a weakened immune system, or have a serious medical problem like diabetes or cirrhosis. Complications may include:
- Acute respiratory distress syndrome . This is a severe form of respiratory failure.
- Lung abscesses. These are pockets of pus that form inside or around the lung. They may need to be drained with surgery
- Respiratory failure. This requires the use of a breathing machine or ventilator.
- This is when the infection gets into the blood. It may lead to organ failure.
What Are Risk Factors For Sepsis
- Very young people and elderly people
- Anyone who is taking immunosuppressive medications
- People who are being treated with cancer chemotherapy drugs or radiation
- People who have had their spleen surgically removed
- People taking steroids
- If a person has sepsis, they often will have fever. Sometimes, though, the body temperature may be normal or even low.
- The individualmay also have chills and severe shaking.
- The heart may be beating very fast, and breathing may be rapid. Low blood pressure is often observed in septic patients.
- Confusion, disorientation, and agitation may be seen as well as dizziness.
- Some patients who have sepsis develop a rash on their skin. The rash may be a reddish discoloration or small dark red dots seen throughout the body.
- Those with sepsis may also develop pain in the joints of the wrists, elbows, back, hips, knees, and ankles.
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What Are The Symptoms Of Sepsis
The following are the most common symptoms of sepsis. However, each person may experience symptoms differently.
People with sepsis often develop a hemorrhagic rasha cluster of tiny blood spots that look like pinpricks in the skin. If untreated, these gradually get bigger and begin to look like fresh bruises. These bruises then join together to form larger areas of purple skin damage and discoloration.
Lose interest in food and surroundings
Complain of extreme pain or discomfort
Feel cold, with cool hands and feet
Become lethargic, anxious, confused, or agitated
Experience a coma and sometimes death
Those who become ill more slowly may also develop some of the signs of meningitis. The symptoms of sepsis may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.
Outcome Measures: Univariate Results
A total of 167 patients died during hospitalisation and 214 died at 30 days. In-hospital mortality was 38 in patients with nonsevere sepsis and 109 in patients with severe sepsis, with the mortality at 30 days being 51 and 131 , respectively. Adherence to the different isolated or combined processes of care with respect to mortality are shown in .
Adherence to antibiotic guidelines was the strongest protective factor for mortality in the whole population and in patients with nonsevere sepsis, and adding further processes of care did not improve survival. In the group with severe sepsis, the odds ratio for the protective effect of the combination of two or three processes of care was better than the odds ratio of a single process of care compared with in-hospital mortality. With regard to mortality at 30 days, only the odds ratio for two processes of care maintained a trend towards lower mortality . The Chi-squared goodness-of-fit analysis demonstrated the adequacy of the model .
In the multivariate models to predict a short stay in the whole population and in the group with nonsevere sepsis, a significant association was found with adherence to one, two or three processes of care . No significant association was found with any process of care in the subgroup with severe sepsis.
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How Long Does Sepsis Take To Kill
According to research from the University of Michigan Institute for Healthcare Policy and Innovation, sepsis can keep killing months later and in some cases even years later .
Patients who have pre-existing conditions are more likely to develop sepsis, and it is not known whether or not this is a contributing factor to the increased risk of death in the 30 days to two years after diagnosis.
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What Are The Chances Of Survival For Someone With Sepsis And Pneumonia
Survival rates for a person with both sepsis and pneumonia are not widely available. The death rate for sepsis patients is between 28 and 50 percent, according to the National Institutes of Health. Pneumonia patients with weakened immune systems have a mortality rate of 30 percent, according to MedicineNet.
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Urgent Advice: Call 111 If:
You, your child or someone you look after:
- feels very unwell or like there’s something seriously wrong
- has not had a pee all day or in the last 12 hours
- keeps vomiting and cannot keep any food or milk down
- has swelling, redness or pain around a cut or wound
- has a very high or low temperature, feels hot or cold to the touch, or is shivering
Do not worry if you’re not sure if it’s sepsis it’s still best to call 111.
They can tell you what to do, arrange a phone call from a nurse or doctor, or call you an ambulance.
Treatment And Prognosis Of Pneumococcal Sepsis
Pneumococcal sepsis is a serious medical condition where bacteria, specifically Streptococcus pneumoniae, infect the blood. The infection of the blood causes the immune system to react at full force and creates an inflammatory response as a counter attack to the bacterial infection. Although caused by the immune system itself, the inflammatory response comes with its own consequences and can cause further damage to the body resulting in permanent damage and possible shutdown of the internal organs.
Pneumococcal sepsis occurs in individuals who have weakened immune systems such as cancer patients, those infected with HIV, recent transplant patients, and those who are recovering from recent invasive surgical operations. Others at risk include young babies, elderly people, and diabetics. Healthy individuals with no prior history of immune system problems or other serious health issues rarely develop pneumococcal sepsis.
The transmission of the Streptococcus pneumoniae bacteria is spread through droplets from coughs or sneezes of infected individuals who are in close proximity to others. In airborne cases, Streptococcus pneumoniae, when inhaled through the lungs, will cause pneumonia. When the bacteria enter the body through a break in the skin, such as a wound or healing closure from a recent operation, sepsis can occur, especially if the individual is taking some kind of immune suppressing drug.
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Complications Of Sepsis And Septic Shock
The decreased blood pressure and small clots lead to a series of harmful complications:
Blood flow decreases to vital organs .
The heart attempts to compensate by working harder, increasing the heart rate and the amount of blood pumped. Eventually, the bacterial toxins and the increased work of pumping weaken the heart. As a result, the heart pumps less blood, and vital organs receive even less blood.
When tissues do not receive enough blood, they release excess lactic acid into the bloodstream, making the blood more acidic or by a buildup of carbon dioxide in the blood… read more ).
All of these effects result in a vicious circle of worsening organ malfunction:
The kidneys excrete little or no urine, and metabolic waste products accumulate in the blood.
The walls of blood vessels may leak, allowing fluid to escape from the bloodstream into tissues and cause swelling.
Lung function worsens because blood vessels in the lungs leak fluid, which accumulates, making breathing difficult.
As the microscopic blood clots continue to form, they use up the proteins in blood that make up clots . Then, excessive bleeding Disseminated intravascular coagulation is a condition in which small blood clots develop throughout the bloodstream, blocking small blood vessels. The increased clotting depletes the platelets… read more ) may occur.
S Leading To Septic Shock
Typically, the body responds to an infection by keeping it where it started. But if an infection cannot be contained to that original site, it can spread to other areas of the body via the bloodstream.
Most infections that lead to sepsis and septic shock are caused by bacteria.
When bacteria from one area of the body enters the bloodstream, it is known as bacteremia or . Unless treated quickly, this can progress into sepsis.
In a typical infection, your immune system releases cytokines to dilate blood vessels at the infection site. This response allows more blood to bring infection-fighting white blood cells to the area.
In sepsis, however, cytokines go into overdrive, creating an overwhelming amount of inflammation throughout the body. This “cytokine storm” damages the heart and its ability to pump blood throughout the body.
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Pleural Effusions Empyema And Pleurisy
There are two layers of tissue surrounding your lungs called the pleura. One wraps around the outside of your lungs and the other lines the part of your chest where your lungs sit. They help your lungs move smoothly when you breathe.
If your pneumonia isn’t treated, the pleura can get swollen, creating a sharp pain when you breathe in. If you don’t treat the swelling, the area between the pleura may fill with fluid, which is called a pleural effusion.
If the fluid gets infected, it leads to a problem called empyema. Tell your doctor if you are having any of these symptoms:
- Hard time breathing
- You don’t want to breathe deeply because it hurts
For pleural effusions and empyema, your doctor may suggest a procedure that removes fluid from your body with a needle. Antibiotics are also an option to treat empyema.
Summary Of Key Results
In this study, we evaluated a large multi-center cohort of patients with pneumonia complicated by septic shock. Overall mortality was high in this population. There were 3048 patients who received appropriate antimicrobial therapy after the development of septic shock with a mean time to appropriate antimicrobial therapy of 10.9 h. Patients who died in the hospital were significantly older and had significantly higher APACHE II scores, number of organ failures, and admission serum lactate. Time to administration of appropriate antimicrobial therapy remained the most important predictor of in-hospital mortality in this population. In the training set , a CART model using APACHE II score, lactate, age, and time to appropriate antimicrobial therapy yielded predictive accuracy of 73%, specificity 75%, sensitivity 71%, and AUROC 0.75. In the testing set , the CART model offered predictive accuracy of 69%, specificity 72%, sensitivity 65%, and AUROC 0.72.
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