It started with a skin infection.
And like a typical Midwesterner, the farmer figured he’d just tough it out.
“A farmer was out doing his job, cut his leg and it ended up with an infection that almost killed him,” said Rachael Nielsen, a nurse practitioner and hospitalist at Methodist Fremont Health.
The man had sepsis, which the Centers for Disease Control and Prevention said occurs when an infection triggers a life-threatening chain reaction throughout the body.
“Sepsis happens when a local infection — like a bladder infection, pneumonia, a skin infection—becomes overwhelming,” Nielsen said. “Whether it’s a bad case or you have let it go for a long time — not gone in to get treatment – the infection takes over.”
When this occurs, sepsis can cause organ damage, low blood pressure and confusion.
“It’s very serious,” Nielsen said, “because even with appropriate treatment up to 40 percent of patients with severe sepsis die.”
Seeking treatment early is important, Nielsen said.
“The faster you get in for treatment, the better our chance of successfully treating it,” she said.
A patient with sepsis might have one or more symptoms: high heart rate; disorientation or confusion; extreme pain; fever, shivering, feeling very cold; shortness of breath; clammy or sweaty skin; or low blood pressure.
“You know you have a respiratory infection, but now you’re having a high fever — 102 or 103 (degrees) — or your family notices you’re getting kind of confused or you feel light-headed, dizzy, because your blood pressure is low,” Nielsen said. “These are serious symptoms and you need to seek medical treatment immediately.”
Sepsis can happen to people of any age and the signs can be subtle as well, Nielsen said.
“You have to really pay attention to what your normal is,” she said.
Two major signs for infants are high fevers and lethargy. Many times, Nielsen said elderly people are taking medications that can mask the symptoms and they tend not to run high fevers.
“So they don’t see it as much of an emergency and put off coming in,” she said.
Patients with dementia can’t always communicate if something is wrong, which why it’s important to watch for signs such as increasing confusion, weakness, lethargy or if the person is sleeping more.
Symptoms can include sudden changes — if the person is suddenly more confused or there is difficulty in waking the individual or if the person isn’t able to do normal activities.
While anyone can get an infection and almost any infection can lead to sepsis, certain individuals are at higher risk. They are:
- Adults age 65 or older.
- People with chronic medical conditions, such as diabetes, lung or kidney disease and cancer.
- Individuals with weakened immune systems. This can be due to chemotherapy or steroid use or an autoimmune disorder.
- Children younger than age 1.
Those exhibiting symptoms need to be taken to their health care provider, an urgent care facility or emergency room.
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“You need to be evaluated by a provider right away,” Nielsen said.
The first treatment involves getting the appropriate antibiotics started.
“For every hour that antibiotics are delayed, we have an increase in 8 percent for mortality,” Nielsen said. “The next thing is to combat low blood pressure. We need to give lots of IV fluids. Sometimes, we need to give medications to support blood pressure.”
This requires hospitalization — frequently in the intensive care unit because patients are very ill.
Sometimes patients have difficulty with consciousness so protecting their airways is important. This can require the insertion of a tube to help the patient breathe.
Patients must be watched closely because their condition can change in a matter of minutes and could result in heart failure, Nielsen said.
“If you don’t treat low blood pressure, you don’t get enough oxygen to the vital organs and they fail,” she said. “Your kidneys and your brain are most susceptible to that.”
According to Nielsen, sepsis isn’t uncommon.
“We average between six and 12 patients a month with sepsis – all year long,” she said. “It’s not seasonal. Any infection can lead to sepsis. We see more in the summertime from skin infections. More from pneumonias in the winter.”
CDC statistics indicate that sepsis takes more than 270,000 lives a year in the United States.
One of the most effective means of preventing sepsis is preventing infection, which includes flu and pneumonia shots, as well as childhood immunizations, Nielsen said.
“Immunizations are so important to reduce the risk of sepsis,” she said.
But Nielsen said it’s not actually the flue virus that causes people to die.
“It’s that it knocks down their immune system and they get secondary infections like pneumonia that can lead to sepsis and death,” she said.
Nielsen said the the farmer who developed sepsis was in the intensive care unit for more than two weeks and was on a ventilator.
“We truly didn’t think he was going to survive,” she said. “He was so sick, some days, he actually had two nurses.”
Several other medical professionals were on the case — that all started with a skin infection.
Fortunately, the man is doing much better.
“He’s a lot better about going to the doctor now. He pays more attention to his health and looks for signs of infection if he would injure himself,” Nielsen said. “He’s much more conscious of that — not only for himself but also for his family.”