Sepsis is a common and potentially life-threatening medical condition that is basically a body’s response to an infection. According to Olander et al. (2019), the definition of sepsis among the medical professionals has recently changed. Since 2016, sepsis has been defined as hazardous organ dysfunction elicited by a dysfunction of the host’s response to an infection. Whatever the definition, sepsis is tough to diagnose due to the heterogeneity in symptoms and, as a result, tough to treat. However, the medical community is aware of the seriousness of the problem and makes everything they can to solve it.
When it comes to the condition’s vital signs and symptoms, these vary in patients with sepsis. Olander et al. (2019) state that breathing difficulty, nausea, vomiting and/or diarrhea, the lack of energy, intense localized pain, chills and/or fever were some of the common symptoms for patients with severe sepsis. However, in an earlier study, a relatively low rate of patients with severe sepsis and septic shock were reported to be suffering from hypotension. Another contradictory sign is the temperature of the body, which is not necessarily high in all sepsis patients, which makes the arrival at a diagnosis more difficult. According to Olander et al. (2019), normal vital signs are generally associated with lower levels of monitoring during in-patient care, which can enhance the risk of undetected deterioration. Moreover, specific symptoms are not associated with sepsis only, which further complicates its identification, with non-specific ones being unfortunately connected to less favorable outcomes.
Evidently, identification of the medical condition is important to its treatment – but in case of sepsis, early identification is absolutely crucial. Smyth et al. (2019) note, in accordance with international guidelines on sepsis, treatment is to be initiated as the first opportunity. Studies had shown that well-documented suspicions of sepsis in electronic medical records shortened the time before antibiotics were administered. The delay until antibiotics are applied, in its turn, leads to enhanced development of severe sepsis to sepsis shock and increased mortality (Smyth et al., 2019). As for the prehospital screening tools to identify patients with sepsis and/or serious sepsis, these include Severe Sepsis score (PRESS), Sepsis Alert protocol, quick Sequential Organ Failure Assessment (qSOFA), Robson screening tool, and BAS 90-30-90. According to Green et al. (2016), with their help, some of the patients’ indicators – heart and respiratory rate, blood pressure, oxygen saturation and others – are measured. One is considered septic if a particular amount of criteria – varying from tool to tool – are met.
In addition to or in the absence of these tools, hospitals resort to other measures such as capnography, lactate meters, and ultrasound. Widmeier and Wesley (2015) state that, while in the United States carnography is used more or less extensively, the other two methods are rather rare. Carnography is the monitoring of the amount of CO2 in exhaled air, which helps monitor perfusion that decreases in septic patients. The trending of lactate acid levels is possible with the help of lactate meters – serum lactate is considered to be a biomarker of patients with severe sepsis. Ultrasound is used to measure fluid status – if there is a great decrease in the inferior vena cava diameter, which is common with septic patients, fluid resuscitation is necessary. All of these, though not one hundred percent accurate, are considered acceptable in using when attempting to determine whether an individual has sepsis or not.
In conclusion, the ambiguity of sepsis symptoms often leads to the medical professionals’ inability to arrive at a proper diagnosis with septic patients. In the meantime, early detection is essential for reducing the risks of adverse outcome due to inadequate evaluation or detained medical intervention. Along with appropriate care, which includes antibiotics, resuscitation, and source control, it is considered to be the most appropriate management strategy.
References
Green, R. S., Travers, A. H., Cain, E., Campbell, S. G., Jensen, J. L., Petrie, D. A.,… & Patrick, W. (2016). Paramedic recognition of sepsis in the prehospital setting: a prospective observational study. Emergency Medicine International, 2016. Web.
Olander, A., Andersson, H., Sundler, A. J., Bremer, A., Ljungström, L., & Andersson Hagiwara, M. (2019). Prehospital characteristics among patients with sepsis: a comparison between patients with or without adverse outcome. BMC Emergency Medicine, 19(1), 1-8. Web.
Smyth, M. A., Gallacher, D., Kimani, P. K., Ragoo, M., Ward, M., & Perkins, G. D. (2019). Derivation and internal validation of the screening to enhance prehospital identification of sepsis (SEPSIS) score in adults on arrival at the emergency department. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 27(1), 1-13. Web.
Widmeier, K., & Wesley, K. (2015). Assessing & managing sepsis in the prehospital setting. Journal of Emergency Medical Services, 39(3), 36-40. Web.