An Overview of Sepsis and Septic Shock

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Surgical nurse scrubs her hands
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Sepsis is a very serious, potentially life-threatening condition that occurs when a localized infection, like a urinary tract infection (UTI) or surgical wound infection, moves into the bloodstream. As the infection spreads, your body launches a massive inflammatory response, causing symptoms like a fever and a fast heart and breathing rate. If untreated, sepsis may progress into septic shock, which causes low blood pressure and subsequent multi-organ failure.

Treatment of sepsis and septic shock require not only treating the underlying infection, but ensuring adequate blood flow to your organs.

Symptoms

Symptoms and signs of sepsis include the following:

  • Fever
  • Sweating
  • Rapid heart rate (tachycardia)
  • Rapid breathing rate (tachypnea)

As sepsis worsens, septic shock may develop, which indicates that the organs in your body are not being sufficiently perfused (that is, they're not getting enough oxygen).

Potential symptoms and signs of septic shock include:

  • Low blood pressure
  • Warm skin followed later by cool and pale skin and a bluish hue of the hands and feet (called peripheral cyanosis)
  • Confusion or decreased alertness
  • Low urine output
  • Swelling (called edema)
  • Liver, heart, and kidney dysfunction
  • Shortness of breath
  • Bleeding problems

If you experience any symptoms of sepsis or septic shock, seek immediate medical treatment.

Causes

Sepsis and septic shock are complex processes, and still not fully understood. Generally speaking, though, sepsis occurs when the body releases several inflammatory markers in response to some sort of an infection (usually bacterial). Rarely, a virus, fungus, or parasite is the cause.

The inflammatory markers released by the body cause arteries to dilate (widen), which compromises blood flow to vital tissues. As the sepsis worsens, septic shock may develop. With this, the oxygen delivery to organs in the body becomes severely jeopardized to the point that organs, especially the liver, kidney, intestines, heart, and lungs, begin to fail.

There are several factors that increase a person's risk for sepsis and septic shock, although healthy people with no risk factors can and do develop sepsis.

Some key risk factors for sepsis and septic shock include:

  • Having an infection after surgery (called a postoperative infection)
  • Treatment with chemotherapy, corticosteroids, or other immune-suppressing drugs
  • Presence of invasive devices, like a urinary catheter, indwelling line, or drainage or feeding tube
  • Use of intravenous drugs
  • Having certain underlying issues like diabetes, cirrhosis, sickle cell disease, or a weakened immune system

Women who are pregnant or who have given birth or experienced a miscarriage within the prior six weeks, newborns and infants under the age of 1, and the elderly (above the age of 75) are also at an increased risk for developing sepsis and septic shock.

Diagnosis

One of the difficulties in diagnosing sepsis quickly and accurately is that the symptoms may be confused with other health conditions, such as food poisoning, the flu, or heart and lung problems. That said, sepsis is relatively rare compared with the common flu, so it often isn't suspected until the individual becomes sicker and exhibits the following physical exam findings:

  • Fever
  • Rapid heart rate
  • Low blood pressure
  • Fast breathing rate

In addition to performing a physical exam, a doctor will order several blood tests to help diagnose sepsis or septic shock. Examples of these blood tests include a complete blood count (CBC), electrolyte panel, creatinine, liver function test, and lactate level. Blood and urine cultures will also be ordered. In some cases, other body fluid cultures—for example, synovial fluid or cerebrospinal fluid—may be ordered as well.

Likewise, imaging tests may be ordered, such as a chest X-ray for possible pneumonia or a computed tomography (CT) scan to look for an infected fluid collection (abscess).

Treatment

People with sepsis and septic shock are treated in an intensive care unit (ICU) by a doctor called a critical care specialist. Due to the severity of the inflammatory response, patients need close monitoring and are usually sedated and placed on a ventilator.

Overall, the main goals of sepsis/septic shock treatment are to:

  • Ensure good blood flow to the organs
  • Treat the underlying infection

Optimizing Organ Perfusion

In order to ensure your organs are getting adequate blood flow, your doctor will give you oxygen and likely place a catheter (called a central line) in a vein in the neck or within the groin in order to give large volumes of fluid rapidly.

In addition to intravenous fluids, your doctor may also use the central line to administer blood or medications that help raise the blood pressure (called vasopressors).

If septic shock has developed, certain organs may fail to the point that an intervention is needed, such as dialysis for kidney failure or a ventilator (if not already placed) to help with breathing.

Treating the Infection

Even before the source of the infection is known, broad-spectrum antibiotics (and less commonly, antifungals) are usually given. Then, once the source of the infection is found, your doctor can address that source—for example, draining an abscess or removing an infected catheter. Your doctor can also narrow down the antibiotics being given based on the type of bacteria suspected or found in a culture.

Prevention

The only way to prevent sepsis is to prevent infection. Standard infection prevention techniques, such as good wound care and frequent hand washing, can help with this.

Specifically, when it comes to washing your hands, the Centers for Disease Control and Prevention (CDC) recommends these five steps:

  • Wet your hands before applying soap.
  • Lather your hands thoroughly with the soap, including the backs of your hands, between your fingers, and underneath your nails.
  • Scrub your hands for at least 20 seconds—the duration it takes for you to sing the "Happy Birthday" song twice.
  • Rinse your hands thoroughly.
  • Dry your hands with a clean towel or air dry.

If soap and water are not available, using hand sanitizer is your next best option.

Other ways to prevent infection include staying up-to-date with your vaccines and promptly getting treated for any infection you have.

A Word From Verywell

The bottom line is that a diagnosis of sepsis is extremely serious, as it can rapidly progress to septic shock, which may result in death. Although the best way to prevent sepsis is to prevent an infection in the first place, it's important to remember that if you do develop an infection, you should seek prompt and appropriate care.

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Article Sources
  • Centers for Disease Control and Prevention. (2018). Wash Your Hands. https://www.cdc.gov/features/handwashing/index.html

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