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Suspected sepsis cases should be treated as an emergency, says NICE
Patients suspected to have sepsis – a serious and potentially life-threatening infection – should be treated with the same urgency as suspected heart attack cases, suggests health watchdog the National Institute of Health and Care Excellence (NICE).
In new guidance published today, NICE urges medical staff to consider sepsis early on when treating any patient that is unwell with an infection.
NICE says that all frontline medical staff – including GPs, paramedics and hospital staff – should ask themselves the question “Could this be sepsis?”, in a similar way that medical staff – when faced with a patient presenting with chest pain – immediately consider heart attack as a possible cause.
What is sepsis?
Sepsis is described as the body’s systemic inflammatory response to microbial infection, which, when left untreated can lead to organ damage and eventual failure, septic shock and death. Figures suggest sepsis is responsible for up to 44,000 deaths in England each year, and some experts suggest that between 5,000 and 13,000 of these deaths may have been avoidable. UK-wide, sepsis could be responsible for as many as 60,000 deaths each year.
Sepsis can begin with a small wound or injury – such as a cut or even a spot, or following an illness, such as a bladder or lung infection. If left untreated, the immune system can overreact and the infection can begin to overwhelm the body and some patients may go on to develop sepsis.
The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) found in 2015 that lives have been lost as a result of delayed diagnosis, at times due to a failure to record and monitor simple observations – such as blood pressure, respiration rate and temperature – and many patients did not receive life-saving interventions, sometimes even when sepsis was suspected.
However, barriers to diagnosis arise as the early symptoms of sepsis may be vague and can be very similar to flu or viral illness, for which antibiotics are not prescribed. In addition, new advice given to GPs regarding antibiotic stewardship - when antibiotics are only prescribed where absolutely necessary – means that in some cases, a relatively minor infection which the immune system of a healthy person is usually able to shake off may develop into life-threatening sepsis in some more vulnerable individuals.
With sepsis, early treatment with antibiotics is crucial to prevent the condition escalating to severe sepsis - when organs begin to show signs of failure - and septic shock, when multiple organ failure has already begun. To further complicate diagnosis, symptoms are said to sometimes vary from person to person, which can lead to delays –sometimes until the condition has progressed to its final stages.
Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, told BBC News: “The problem with those patients who died unnecessarily of sepsis is that staff did not think about it soon enough."
He adds: "This is complicated medicine. It requires a depth of thought and experience and a way of examining patients which isn't always there - particularly because of time pressures and partly because we have got used to implementing guidelines without thinking."
Sepsis diagnosis a “huge worry for GPs”
Dr Maureen Baker, of the Royal College of General Practitioners, says: "The diagnosis of sepsis is a huge worry for GPs, as initial symptoms can be similar to common viral illnesses, so we welcome any guidance or support to help us identify it as early as possible.”
What are the symptoms?
UK Sepsis Trust – six most common warning signs in adults
The UK Sepsis Trust, founded by medical professionals, aims to save lives by bringing the issue to the attention of government, raising awareness of sepsis via educating other health professionals and the public and also supporting survivors and the bereaved. As a result of its work with sepsis survivors, the charity has identified the six most common warning signs of sepsis in adults:
- confusion or altered mental state, slurred speech
- extreme shivering and muscle pain
- passing no urine
- a strange feeling that you may be dying
- mottled or discoloured skin
- blood pressure may be abnormally low.
The above signs may be indicators that the organs are not receiving enough oxygen, therefore experts urge those who suspect sepsis not to wait for these red flags to appear and to seek medical attention immediately. Other signs include a high temperature, or a low temperature which may indicate severe sepsis.
Symptoms in babies and young children
In babies and young children, a range of symptoms can appear differently and may include:
- cold hands and feet with a blue tinge
- sleepiness or not responding to carers
- rapid, noisy breathing
- diarrhoea and/or vomiting.
Who is susceptible to sepsis?
While anyone can develop sepsis, it is more common in babies and young children, in elderly people and in those who are immunosuppressed. Pregnant women up to six week’s post-partum and people who have recently had surgery, or have had an intravenous line or catheter, are also said to be slightly more at risk of developing sepsis.
Sepsis can develop rapidly, particularly in the very young or old, so if you suspect a series of events may have developed into sepsis it is vital that you seek urgent medical attention, taking care to outline all of the symptoms that you or your loved one is experiencing. Write down what has been happening in a consecutive order and take it with you.
For more information, you may wish to read our previous article here.
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