Nurses Suspect Sepsis Educational Video


>>Welcome. Today, we would like to
discuss the importance of suspecting sepsis in
every patient you treat. So more survive. The incidence of
sepsis is startling. Every two minutes in the
United States someone dies of sepsis and, globally, we
lose someone every four seconds. With prevention and timely
sepsis identification and treatment, we can greatly
reduce the incidence of sepsis and save lives and
reduce suffering. In the hospital setting, sepsis
is the leading cause of death and contributes to one in
every two to three deaths. Of these deaths, the
majority of patients presented to the hospital with sepsis. Sepsis accounts for 258,000
deaths a year in the US. This is greater than the number
of deaths from breast cancer, prostate cancer,
and AIDS combined. Many times, there
is a disconnect in identifying sepsis. This is due to common
sepsis myths. Many believe sepsis only
affects the elderly and patients with significant comorbidities. In addition, many individuals
believe it won’t happen to them or their family members. This couldn’t be
further from the truth. Sepsis can affect
anyone at any time. However, some groups
are at higher risk for developing sepsis
— the young, the old, and those with chronic
illnesses. We will be introducing you to some individuals whose
lives have been forever changed by sepsis. Meet Dr. Carl Flatley, a retired
endodontist from Florida. His daughter, Erin, was
a healthy 23-year-old.>>In 2002, my daughter
came home from college. She was going to
graduate school and went in for a simple outpatient
surgery. She had that done on Wednesday. Sunday night, we took her back
to the hospital and, on Tuesday, she was dead
from something I had never heard of. I was with Erin when she
died, and she looked at me and her eyes said, “Can’t
you do something, Dad?” I mean, she was scared. And she was gone just like that. Sepsis is an overreaction
of the body to infection and it can cause
death or disabilities.>>When Carl lost Erin, he looked around
for an organization to help put his resources into. He found that there was no
organization at that time that was doing any work
around sepsis advocacy. So Carl Flatley did what Carl
Flatley does, he said, “Well, heck, I’m going to
have to do it myself.”>>There became a determination
that I saw in Carl’s eyes that I’ve never seen before to
find out answers to questions that we didn’t know
and to make sure that no other parent
experienced the loss of a child from sepsis as he had to endure.>>Sepsis kills more people than
breast cancer, prostate cancer, and AIDS put together.>>Twelve children every day
die of sepsis and that’s more than cancer so we have a huge
awareness challenge in front of us to get that word out.>>The goal of Sepsis
Alliance is public awareness because if a patient does not
recognize the early symptoms, a lot of times they don’t
get to the hospital on time to get the appropriate
treatment.>>When I joined Sepsis
Alliance in 2007, fewer than 20% of the US population had
heard of sepsis before. We still have a lot of work to
do but, before Carl got started, 19% — and now, we’re
at more than 50%.>>Without Carl, we wouldn’t
have protocols to manage sepsis in almost every hospital
in the country. Without Carl, children would
be dying more frequently than they are today. He single-handedly has
changed the way we think about sepsis in America.>>The success of Sepsis
Alliance to spread awareness and save the lives of others
would verify what Erin said — “Can’t you do something, Dad?” This would, in fact,
verify that I did something. She would really be happy.>>Meet Zach. At the age of 11, Zach
developed sepsis from MRSA. What is particularly interesting
about Zach’s experience is that Zach’s mother is
a family physician. Since her son was a healthy,
vibrant boy, it never occurred to her that Zach
could have sepsis.>>It was a regular Wednesday. We met Zach at the game and, after the game, he
started to cry. And the first thing he
said was, “My knee hurts, I have a headache,
and I’m dizzy.” Over the course of the next
four days, he became more and more ill and,
on Saturday evening, we took him to the
emergency room. They immediately started IV
antibiotics and, finally, by that evening, we were
told that he needed to be put into a medically-induced coma
to be put on a respirator. And, at that point,
the diagnosis of sepsis was confirmed. He stayed that way for 12 days
and had multiple complications. I kept thinking, “Am I going
to be a mom who loses a child?” It can happen to your
parent, it can happen to your spouse, it
can happen to you. So you need to know what
it is and what to look for.>>Today, Zach is
happy and healthy but there are some lingering
effects from his experience with sepsis and his mother was
left with a feeling of disbelief that she didn’t pick up on it. Meet Lisa. Lisa’s husband, Jeff,
suddenly became ill at work and sought medical treatment at
a local emergency department. Sepsis was not recognized
during the initial evaluation. The first doctor who saw
him said Jeff had the flu, a common pronouncement when people present
with sepsis symptoms. Jeff was still in the
emergency department though because he hadn’t
been discharged yet. He continued to decline,
becoming hypotensive and complaining of having
the worst pain ever. Sepsis was finally identified
when Jeff was in septic shock. He died hours later. He was only 40 years old. Sepsis can be challenging
to identify. Many times, patients present to the hospital with
subtle symptoms. This may delay arrival to
the emergency department, recognition in triage, or recognition during
hospital admission. Many times, symptoms of sepsis
mimic less severe conditions. With sepsis, often, the patient’s condition
escalates rapidly. No one department owns sepsis. Some communities have
limited sepsis identification and management resources in
their healthcare facilities. To increase awareness of
sepsis and when to seek help, Sepsis Alliance has
developed a sepsis mnemonic and several resources. One example is, “Symptoms of
Sepsis” — S, shivering, fever, or very cold; E, extreme pain or
general discomfort, worst ever; P, pale or discolored skin;
S, sleepy, difficult to rouse, confused; I, I feel like I
might die; S, short of breath. Children are not small adults and their sepsis symptoms
differ from adults. Because of this, Sepsis
Alliance created references for recognizing sepsis
in a child. One or more of the following
symptoms may indicate a critical illness. Any child who: feels abnormally
cold to touch, looks mottled, bluish, or has very pale skin,
has a rash that does not fade when you press on it,
is breathing very fast, has a convulsion,
is very lethargic or difficult to wake up. A child under five who: is not
eating, is vomiting repeatedly, has not urinated in 12 hours. What is sepsis? It all starts with a source
of infection, any infection. Sepsis is the body’s
overwhelming and life-threatening response
to infection which can lead to tissue damage, organ
failure, and death. Sepsis can be caused by
any type of infection — bacterial, viral,
fungal, or parasitic. Recognition of sepsis is
key to early intervention. Two methods are available
to assist in recognition: SIRS criteria and SOFA criteria. A modified version of
SOFA is called qSOFA. SIRS stands for Systemic
Inflammatory Response Syndrome. This syndrome may occur
as the body responds to infection or injury. It is important to remember
noninfectious disorders may also cause SIRS. Once a patient has a
source of infection, we need to evaluate
further to determine if there is a systemic
inflammatory response happening. Does the patient have any two of the following
criteria, plus infection? Temperature greater than
38.3 degrees Celsius, 101 degrees Fahrenheit, or
less than 36 degrees Celsius, 96.8 degrees Fahrenheit,
heart rate faster than 90 beats per minute,
respiratory rate faster than 20 breaths per minute,
white blood cell count higher than 12,000 or lower than
4000, bands 10% or higher. If so, the patient has sepsis. It is important to remember
some patients are on medications or have underlying conditions that limit the ability
to respond. An example is certain
heart medications limit or decrease the ability
for increased heart rate. SOFA is the acronym for Sequential Organ
Failure Assessment Score. A higher score is associated with increased incidence
of mortality. A change in baseline of the
total score by two points or more represents
organ dysfunction. This tool is complex and
requires laboratory values as part of the criteria. The Sepsis Definition Task Force
developed a modified version of the SOFA that
maintains high reliability in predicting severity
of illness. This is called the qSOFA. The score ranges
from zero to three. It can be assessed
immediately upon presentation and does not require
laboratory values. Patients with suspected
infection who are likely to have a prolonged
ICU stay or to die in the hospital can
be promptly identified at the bedside with qSOFA. A score of qSOFA of two
or higher is predictive of increased mortality. Sepsis is the presence
of infection, suspected or confirmed, with a systemic
response to infection. Sepsis escalates to septic shock when there is persistent
hypotension despite fluid resuscitation and/or tissue
hypoperfusion, which is seen by an elevated lactate level. The latest sepsis guidelines has
removed the term severe sepsis and categorized that
into septic shock. What exactly happens to a
patient as they escalate from sepsis to septic shock? It begins with an organism
that results in an infection. The body develops a systemic
inflammatory response, which causes diffuse
endothelial disruption and microcirculation defects. This results in global tissue
hypoxia and organ dysfunction. When multiple organ dysfunction and refractory hypotension
occurs, it is called septic shock. The greatest unknown is the
number of sepsis survivors. Many sepsis survivors
live with disabilities for the rest of their lives. These consist of but are
not limited to the obvious, such as amputations, to the
less obvious, such as problems with memory, thinking,
and calculations. Many suffer from post traumatic
stress disorder and they live in fear of becoming
ill once again. Worse, many feel as
if they are all alone. They feel that no one
understands what they’ve gone through. They’re often told that
they’re lucky they survived. It has also been reported that many caregivers also
experience cognitive, emotional, and financial challenges. How do we provide the highest
quality of care for our patient? Once sepsis is suspected,
early initiation of therapy is of essence. The sepsis bundles have
been developed to streamline and standardize evidence-based
practice. The 3-hour bundle is to be
completed within three hours of time of presentation:
measure lactate level, obtain blood cultures prior to
administration of antibiotics, administer broad-spectrum
antibiotics, administer 30 milliliters
per kilogram crystalloid for hypotension or lactate that is 4 millimoles
per liter or higher. Early recognition and treatment of sepsis may prevent
development of septic shock. The sepsis bundles use lactate as an indicator of
tissue perfusion. The body’s energy
needs are mainly met by aerobic metabolism,
which requires oxygen. If there is a lack of
oxygen in the body, it reverts to anaerobic
metabolism, of which lactic acid
is a byproduct. This may, in turn,
lead to lactic acidosis or a decreased physiological
pH. This is an emergency and requires immediate
medical attention. Elevated lactate levels tell
you that there are tissue beds in your body that are having
to function without oxygen. As perfusion is improved,
lactate levels usually decrease. The 6-hour bundle has
the following elements: apply vasopressors
for hypotension that does not respond to
initial fluid resuscitation to maintain a mean
arterial pressure, MAP, of 65 millimeters of
mercury or higher. In the event of persistent
hypotension after initial fluid
administration, MAP of less than 65
millimeters of mercury or if initial lactate was 4
millimoles per liter or higher, reassess volume status
and tissue perfusion and document findings. Re-measure lactate if
initial lactate is elevated. Reassessment and documentation
are critical for evaluation and communication of the
response to interventions. The required reassessment
of volume status and tissue perfusion includes either:
repeat focused exam after initial fluid
resuscitation by licensed independent
practitioner, including vital signs,
cardiopulmonary assessment, capillary refill,
pulse, and skin findings, or two of the following,
measure CVP, measure ScvO2, bedside cardiovascular
ultrasound, dynamic assessment of fluid responsiveness with passive leg raise
or fluid challenge. In addition to blood cultures
and lactate, there are a variety of lab tests to assist us
in evaluating a patient that we suspect has sepsis. Procalcitonin is a
prohormone of calcitonin. It is secreted by many
cell types and organs after bacterial pro-inflammatory
stimulation. Elevated procalcitonin levels
indicate bacterial infection accompanied by a systemic
inflammatory reaction. Localized infection
generally does not increase circulating procalcitonin. Slightly elevated
levels are associated with a mild systemic
inflammatory response to bacterial infection. Very elevated PCT levels are
associated with acute disease with severe systemic reaction, such as severe sepsis
and septic shock. Procalcitonin is a useful
tool for optimization, treatment duration,
and de-escalation of antibiotic therapy in
a bacterial infection. It increases early,
three to six hours after an infectious challenge,
and has a highly specific rise in response to severe
systemic bacterial infections. Levels are usually low
in viral infections, chronic inflammatory,
and autoimmune disorders. Procalcitonin levels in sepsis
are usually more than .5 to 2 nanograms per milliliter,
may reach levels of 10 to 100 nanograms per
milliliter or more. C-reactive protein is an
additional inflammatory marker available for sepsis screening. A rise in the plasma
concentration of C-reactive protein
in the absence of other noninfectious
causes of inflammation — examples, trauma,
surgery, etc. — may be suggestive of infection. While this test is useful,
there are limitations. Severe liver disease
may reduce the amount of C-reactive protein elevation. Sepsis may be present
despite a normal value. Nurses are the key
to suspecting sepsis. Suspect sepsis, save lives. Advocate for every patient. As nurses, we commit to
bringing the right care to the right patient at the
right time so more survive. Sepsis Alliance is the
nation’s leading not-for-profit organization focused on saving
lives and reducing suffering by raising awareness of
sepsis as a medical emergency. Follow us on Facebook,
Twitter, LinkedIn, and Instagram to learn more about sepsis. For more information and to get
involved with Sepsis Alliance, you can visit us at sepsis.org.>>My mother, a 20-year
breast cancer survivor, she dies of a disease that
we had never even heard of.>>Septic shock, sepsis — and she was like,
how do you spell it? I said, “I don’t know.”>>Really, does it
affect that many people? Then why haven’t I heard of it? [ Music ]>>My mother, Mama. She had plans of being a
gospel singer [singing]. They found a clot in
her femoral artery. She got through that surgery but
she started complaining of a lot of weakness, couldn’t
catch her breath. When I heard the word “sepsis,”
I didn’t understand it.>>I remember that
I went to bed, woke up to find the
EMTs in my room. My doctor friend called the
hospital and said, “Look, unless somebody’s coding,
there’s no one in there as sick as this man is. Right now, get a
doctor in there.” In the next few hours, I had
one shutdown after another, all of my organs — lungs, kidneys, eventually
a heart attack. My toes were blackened
and gangrenous. It was very unclear as to
whether I would survive.>>It was Halloween. He was up and crying and crying. I took his temperature — 102.3
— and his color was gray — his lips, his everything was
gray and he was not responding. We got to the hospital. He had swelled up
so he was huge. And one of the doctors
said, “We don’t know if you’ll be able
to take him home.” I’d been waiting for him
for all of these months and I’ve only had him
three weeks — he’s mine! I wish I would have
asked more but I felt like I was supposed
to know as a mother.>>I didn’t understand that
any infection could result in a toxic response
that is known as sepsis. It started when I
went to the dentist and had some dental work. Following that, I developed an
infection and then septic shock.>>I can’t even describe to you
the horror of seeing her die of sepsis — the body
swelling up twice its size, fingers turning black,
having to be intubated. It looked like someone took a
shotgun and shot her in the leg. That’s what it looked
like [singing].>>For me, this could have
a very different ending and it’s why I share
my survivor story.>>And the nurse, her name
was Annie, and she says, “Are you ready to hold him?” I said, “Oh, my God, yes!” And she put him in
my arms and she says, “He’s going to be okay.” I thought, “Maybe if I
share my story, you know, somebody will learn from it.”>>Mama’s gone, but maybe
somebody else can be saved. [ Music ]

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