with Team BUGS
Sepsis is a medical emergency.
Once sepsis is diagnosed, treatment should begin as quickly as possible. Again, it is important to remember that the key for survival and reducing serious lasting disabilities is early recognition (U C T B R H) and prompt treatment.
In addition to the treatments outlined below, someone who has sepsis may need to have surgery in order to control the source of the infection. I have had sepsis myself and I demanded a second opinion from a surgeon to see if it would stop the progression. In fact, I had two surgeries in the following two days that I believe was key to my recovery.
Speak up! It is OK to ask for another opinion if you are not getting answers!
Swift and prompt treatment with antibiotics and intravenous (IV) fluids is the cornerstone of sepsis treatment. For every hour of delay in receiving antibiotics and fluids, your chance of dying goes up 8%. This is why YOU have to be part of the early recognition and seek medical treatment immediately.
Antibiotics kill bacteria and prevent them from spreading. For patients with sepsis, doctors will usually begin a broad-spectrum antibiotic even if they don't know what the infection is yet. This type of antibiotic works against a broad range of bacteria. As treatment begins, the doctors will try to identify where the infection is, if they don't know, and what is causing it. They will test with special blood tests called blood cultures, urine samples, throat swabs, and samples from wounds and other areas.
Once the doctors have narrowed down the type of infection, they can fine tune the antibiotics, taking out what they don't need and changing or adding others.
Unfortunately, there are times when the cause of the infection is never found.
Intravenous (IV) fluids
IV fluids are an important part of sepsis treatment. The fluids help keep the blood pressure from dropping too low, which can cause shock. The fluids also help keep the body's organs working by providing oxygen and nutrients, reducing the risk of organ dysfunction, or having them shut down.
In addition to the antibiotics to fight the infection, other medications may be needed to manage the sepsis, severe sepsis, or septic shock.
Vasopressors: If the blood pressure drops too low, the body's organs cannot get the necessary oxygen and nutrients they need to keep functioning properly. While IV fluids do help by giving extra fluid, they may not be enough. Vasopressors constrict the blood vessels (make them smaller), which helps raise blood pressure. Patients who are on vasopressors must be monitored closely.
Corticosteroids: Corticosteroids, sometimes shortened to "steroids" may also be used to manage sepsis. The corticosteroids reduce inflammation, which can help reduce tissue damage. They also work on decreasing the effect of the immune system.
The human body needs oxygen to work properly. The oxygen is fuel for the organs, which include the kidneys, liver, brain, and heart. If your oxygen level is low, you will be given supplemental oxygen, usually with a mask. This concentrated oxygen goes into the lungs and then into the blood stream.
If you develop breathing problems and cannot breathe effectively on your own, the decision may be made to put you on a ventilator or respirator - a breathing machine. The doctors insert a tube into the trachea, or airway. This is called intubating a patient. This tube is connected to a ventilator, which then pushes air into the lungs. The force of the breaths can be adjusted to each patient's needs. Some patients need just a little bit of help while others need the machine to do all of it.
Surgery may be needed in some cases to contain the infection. For example, if the infection is in a joint, surgeons may want to operate to clear out the area if antibiotics aren't working.
Sometimes, more drastic surgery is needed, such as amputations. Sepsis can cause excessive clotting in the blood vessels, preventing blood flow to the limbs. If this happens, the tissues can die, causing gangrene. This must be removed to keep it from spreading. The surgeons try to remove as little as possible and sometimes they can manage by just removing some of the tissue.
One of the first signs of sepsis is a drop in the amount of urine you put out. The kidneys are sensitive organs that can become damaged by sepsis. However, they are very necessary because they filter many toxins out of your blood.
If your kidneys are not working properly, the toxins will build up. To help manage this, your doctor may request dialysis, or continuous renal replacement therapy. There are two types of dialysis: hemodialysis, which filters the toxins from the blood, and peritoneal dialysis, which uses a system of fluid exchange in the abdomen.
Extracorporeal membrane oxygenation (ECMO)
Life support is the most drastic of life saving measures. Extracorporeal membrane oxygenation (ECMO) is intensive treatment that works to help keep a person alive when the body's organs are shutting down. It is like the heart/lung bypass machine that surgeons use in operating rooms when doing open heart surgery.
To prepare a patient for ECMO, doctors must place a cannulae, which is like a big IV tube, that will allow blood to flow from the patient to a special machine that will "clean" the blood and provide oxygen. The blood then will go back though another cannulae to provide the body with the needed oxygen.
Patients who are on ECMO are very ill and are in the intensive care unit. At first, usually the patient is given a strong medication that sedates them (puts them into a deep sleep) and artificially paralyzes them. This allows the body to rest. After a few days, the doctors usually start to wake up the patient, even if the ECMO is still going.