Category: Health

Research shows ‘unprecedented’ rise in infant mortality linked to poverty in England

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Slide from my presentation on neoliberalism, the still face paradigm and poverty at Beyond the Therapy Room psychology conference, 2019.

According to new research, an unprecedented rise in infant mortality in England is linked to poverty, according to new research. An additional 570 infant deaths, compared to what would have been expected based on historical trends, were recorded in the country from 2014-2017. Around one-third of those deaths, which related to children under the age of one, were linked to rising poverty.

The results of the new study by researchers from the University of Liverpool, University of Leeds and Newcastle University, which analysed data from 2000-2017, have now been released. In their report, published in BMJ Open, the researchers note that infant mortality rates often act as an indicator of the changing overall health of societies, as well as an early warning system for future adverse trends.

Rising infant mortality is unusual in wealthy, high income countries, and international statistics show that infant mortality has continued to decline in most wealthy countries in recent years. 

But in England, social security cuts in the last decade have taken their toll on the poorest communities.

In the study, the researchers grouped 324 local authorities into five categories (quintiles) based on their level of income deprivation, with Quintile 1 being the most affluent and Quintile 5 the most deprived.

Inferential testing – using a statistical model –  was used to quantify the association between regional changes in child poverty  and infant mortality during the same period. 

The researchers found that “a sustained and unprecedented rise” in infant mortality in England from 2014-2017 was not experienced evenly across the population.

In the most deprived local authorities, the previously declining trend in infant mortality had reversed and mortality increased. This led to an additional 24 infant deaths per 100,000 live births per year, relative to the previous trend.

There was no significant change from the pre-existing trend in the most affluent local authorities. As a result, inequalities in infant mortality increased, with the gap between the most and the least deprived local authority areas widening by 52 deaths per 100,000 births.

Overall from 2014-2017, there were a total of 572 “excess infant deaths” compared to what would have been expected based on historical trends, the report says.

The researchers estimate that each 1% increase in child poverty was significantly associated with an extra 5.8 infant deaths per 100,000 live births.

The findings suggest that about one-third of the increases in infant mortality between 2014 and 2017 may be attributed to rising child poverty, equivalent to an extra 172 infant deaths.

Professor David Taylor-Robinson of the University of Liverpool, the lead author on the research, said the study “provides evidence that the unprecedented rise in infant mortality disproportionately affected the poorest areas of the country, leaving the more affluent areas unaffected”.

“Our analysis also linked the recent increase in infant mortality in England with rising child poverty, suggesting that about a third of the increase in infant mortality from 2014-17 may be attributed to rising child poverty. 

“These findings are really concerning given that child poverty is rising. It is time for the government to reverse this trend establishing a welfare system that protects children from poverty.” 

Taylor-Robinson said child poverty has “a myriad of adverse impacts on other aspects of child health that will have repercussions for decades to come”.

“In the context of increasing health inequalities in England, policies that reduce poverty and social inequalities are likely to reduce the occurrence of infant mortality and that of many other adverse child health outcomes,” he added. 

Cuts to social security 

The report notes the impact of “sustained reductions” in social security benefits in England in the last decade. It states: 

“Since 2010, there have been sustained reductions in the welfare benefits available to families with children, including the abolition of child benefit and child tax credit for the third child or more; reductions in the value of tax credits and below-inflation up-rating of most working-age benefits; housing benefit reforms including the under occupancy charge (most commonly referred to as ‘bedroom tax’) and introduction of universal credit; and household caps on total benefit receipt (regardless of how many children are in the household).

“These welfare changes have disproportionately affected the most deprived local authorities and regions and have led to a rise in child poverty.”

Dr Paul Norman of the University of Leeds, who also worked on the research, noted that the findings show “an unprecedented rise in the deaths of children under one year of age”.

He said the researchers’ next step is “to examine the gestational age and the number of weeks at which infants die, to learn more about when key interventions may be needed or when they are being missed”.

“This will inform the urgent action needed by national and local governments, and help drive the health and social care policies needed to reduce infant mortality rates,” Norman said. 

The facts and figures from the Child Poverty Action Group (CPAG) show the reality of child poverty in the UK, and which groups are affected most:CPAG Infographics July 2019 v1-04

Related

Studies find higher premature mortality rates are correlated with Conservative governments

Austerity is “economic murder” says Cambridge researcher

Suicides reach a ten year high and are linked with welfare “reforms

Conservative governments are bad for your health

 


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DWP is trying to co-opt GPs in forcing ill people into work

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Yesterday on Twitter, I posted one of my previous posts – Jobcentre tells GP to stop issuing sick notes to patient assessed as ‘fit for work’ and he died in which I discuss a letter addressed to a GP regarding a seriously ill patient. It said:

We have decided your patient is capable of work from and including January 10, 2016.

“This means you do not have to give your patient more medical certificates for employment and support allowance purposes unless they appeal against this decision.”

The patient, James Harrison, had been declared “fit for work” and the letter stated that he should not get further medical certificates. 

However, 10 months after the Department for Work and Pensions (DWP) contacted his doctor without telling him, he died, aged 55. James clearly wasn’t fit for work. 

The GP had stopped issuing medical certificates when the DWP told him to. It is completely unacceptable that James Harrison was left struggling without support, when he was clearly very ill. It is also unacceptable that James’ GP was given instructions from the state – that caused harm – without James’ knowledge. 

The certificates – so-called fit notes – demonstrate that the government seems to have some difficulty in recognising that sometimes people get ‘sick’ and require support via the provision they have paid into.

Austerity: When the state takes money from the public and hands it out to millionaires

David Cameron, however, had other plans for the UK. He said: “We simply have to get to grips with the sicknote culture that means a short spell of sickness absence can far too easily become a gradual slide to a life of long-term benefit dependency.

“The new welfare bill – described as the biggest shake-up of the system since it was set up 60 years ago – is designed to say end the culture of the fit and healthy being able to refuse work being rewarded for staying at home.”

However, the statement isn’t coherent. He infers that people are recovering from a brief period of illness and then refusing to return to work. As we have learned at great human cost over the last few years, this legislation has destroyed the lives of thousands of people who are ill. It was always intended to take away support from those who need it most. That is evident in the Conservatives’ incoherent attempt at a justification narrative, propped up by the right wing media. 

It never seemed to have crossed Cameron’s mind that 1) people’s medical conditions may worsen, they may have a chronic or degenerative illness. Being chronically ill does not make a person ‘benefit dependent’, it simply makes them ill. 2) The public contributes to the treasury, which is in part a funding mechanism towards social security and other state provisions, via tax and national insurance. This is done on the understanding that the state ensures that citizens can meet their basic survival needs. The Conservatives have clearly stated they have ‘other’ ideas on how our public funds should be spent, which does not include meeting the needs of the public.

The state is responsible for handling public funds. It is unacceptable that such contentious neoliberal ideology is being used by the Conservatives to dismantle state provision for those who need it most, while deliberately targeting the poorest citizens with austerity cuts. Meanwhile, millionaires are rewarded with generous tax cuts from the public purse. At the time when the welfare reform act was passed, millonaires were handed a tax cut of £107,000 each per year. This callous and unjustified approach to social administration is destroying people’s lives and has profoundly damaged our democracy and society, while seriously and systematically violating the human rights of the UK’s most marginalised groups.

It is very worrying that the clearly dangerous ESA65B form is a standardised response to GPs from the DWP following an assessment where someone has been found fit for work.  I discussed some of the raised issues further in another article from last year that I posted on Twitter yesterday – GPs told to consider making fit notes conditional on patients having appointment with work coach 

It’s even more worrying that the part clarifying ‘fit notes’ should continue if a person is appealing a ‘fit for work’ has been removed from the standard letter, and a line added that says: “In the course of any further consultations with […] we hope you will also encourage [the patient]in [their]efforts to return to, or start, work.” 

I always worry when the government uses the words “encourage”, “help” and “support” in the context of policies and political practices that affect disabled people. They are usually techniques of neutralisation – euphemisms for the actions embedded in punitive and harmful policies.

This growing practice of the state intruding in the confidential relationship between a GP and patient undermines trust, it damages the professionalism and clinical expertise of doctors and threatens the safety and wellbeing of patients. It shrinks the safe spaces for citizens to escape the increasingly oppressive practices of the government. It turns GPs into non-neutral agents of the state.

We know from the high rate of success at appeal for Employment and Support Allowance claims that the DWP’s decision making regarding ill and disabled people’s ‘work capability’ is truly atrocious and negligent, and there is absolutely no convincing empirical evidence that “work is a health outcome”. (See: Work as a health outcome, making work pay and other Conservative myths and magical thinking.)

Last year, jobcentre staff were forced to withdraw guidance that urged GPs in Leeds to use deceitful tactics to attempt to get people who are ill off social security support and into work. The shocking guidance asked doctors to send patients for a 45-minute session with a “Patient Coach” – without mentioning that the coach actually worked for the the DWP.

It was even suggested that GPs withhold sick notes unless patients agreed to attend an appointment with the work coach. 

This is a tactic many of us have previously warned of – the government attempting to co-opt doctors to police ill and disabled people, pushing them into work, regardless of whether or not it is appropriate or safe to do so. But it also indicates the direction of travel for healthcare in the UK. The government intend to make that provision conditional also. (See Tories propose nudge, big business AI initiative and ‘personal responsibility’ in place of adequate health care funding.)

The government is forcing people who are ill into either work or into poverty, and both  outcomes are absolutely ethically unacceptable, a violation of rights, authoritarian and very dangerous. Increasingly, poverty is being used as a weapon to coerce people into work. However, many jobs are not paying enough for people to meet their living costs, so it is no guarantee that work will alleviate poverty.

The government seems to think that citizenship rights ought to be entirely conditional on people being economically useful to the government.

If we fail to be so, we are being treated as disposable political commodities. But citizens are not a means to state imposed ends and ideological aims in wealthy so-called first world democracies. And democratic governments don’t generally impose ‘behavioural change’ techniques on citizens, or professionals, for that matter, in order to make them complicit in the abuse and oppression of marginalised groups. The state is increasingly policing and punishing the poorest citizens, leaving them completely isolated and without any reliable support whatsoever.

The ESA65B is misleading GPs and deterring people from appealing wrongful  DWP decisions

On the DWP’s ESA65B GP’s letter template most recently placed on the government site, titled “Help us support your patient to return to or start work” it says: “We assessed [Title] [First name] [Surname] on and decided that [select] is capable of doing some work, but this might not be the same type of work [select] may have done before.

“We know most people are better off in work, so we are encouraging [Title] [First name] [Surname] to find out what type of work [select] may be able to do with [select] health condition or disability through focused support at [select] local Jobcentre Plus.

“In the course of any further consultations with [Title] [First name] [Surname] we hope you will also encourage [select] in [select] efforts to return to, or start, work

“Please do not give [Title] [First name] [Surname] any more fit notes relating to [select] disability/health condition for ESA purposes.

The problem is that people appealing wrongful DWP work capability decisions need to provide sickness certification in order to proceed.

Minister for disabled people, Sarah Newton, responded to one of several Written Questions from Emma Dent Coad, saying: “The ESA65B letter is issued to GPs in every case where an ESA claimant has been found ‘fit for work’. This process was built into the IT system as part of the introduction of ESA in October 2008. 

“Following a Ministerial requirement by the Cabinet Secretary, which was endorsed by the Secretary of State for Work and Pensions, the content of the ESA65B letter has been improved in order to explain to GPs the type of support customers can expect to receive from their local Jobcentre, and to ask GPs to encourage customers in their efforts to return to work.” [My emphasis]. 

GPs are trained and tasked to objectively address health and wellbeing, they should not be co-opted as government ideologues.

The decision to change the letter template was made without any scrutiny from or consultation with parliament and the public. It’s worth reading the series of questions by Emma Dent Coad. Prompting accountable and transparent answers from Sarah Newton appears similar to an exercise in pulling teeth. The responses given display the arrogance, contempt and delusions of an authoritarian government.

When people become ill, they make an appointment with my GP, and not the secretary of state for work and pensions, and for very good reasons. People need support and treatment, not someone spouting ideologically orchestrated dangerous claptrap about how work is ‘good’ for them. It seems the notion of convalescence and recovery are incompatible with the government’s aim of “getting Britain working”.

Catastrophically inaccurate assessments within the DWP are the norm. The government are intentionally reducing access to essential support and services for ill and disabled people, and this ideological attack is causing material hardship, suffering, distress and sometimes, it is killing people. 

The contentious “fit for work” assessment is forcing severely ill people to look for work and sanctioning them if they’re exhausted, in too much pain to get out of bed, while delays in social security are forcing cancer patients to food banks, and the bedroom tax results in bed-bound ill and disabled people facing horrifying threats of eviction. 

These are the direct consequence of intentionally punitive government policies, which aim at enforcing ‘personal responsibility’ and ‘behavioural change’ on those citizens with the fewest choices.

Dan Carden’s letter to Amber Rudd

I was pleased to see Liverpool Walton MP Dan Carden’s letter to Amber Rudd (below) which addresses some of the concerns many of us have raised. He also notes that without a GP’s ‘fit note’, (the Conservative’s Orwellian rebrand of the sick note) it isn’t possible for people challenging Department for Work and Pensions (DWP) decisions to claim Employment and Support Allowance (ESA) in the interim period, until their appeal is heard at Tribunal. 

Indeed, people who have lodged an appeal against a wrongful decision have been blocked from claiming ESA while awaiting the hearing, due to the misleading letter routinely sent from the DWP to doctors. This prevents untold numbers of low-income claimants from accessing financial support while they wait for months on end to go to tribunal. 

Entitlement to ESA pending appeal is enshrined in the ESA Regulations to cover the whole of the period leading up the hearing. It is also possible to have the payment backdated to cover the Mandatory Review waiting period too – it can take over six weeks for the DWP to review their original decision, over which time people are left without welfare support.

However, ESA pending appeal is not paid automatically – people usually have to ask for it, and must provide fit notes from their GP, presenting these along with their appeal acknowledgment letter from the Tribunal Courts to their local Job Centre. The Job Centre should report back to the DWP who will arrange for ESA pending appeal to be paid.

It simply isn’t appropriate for the DWP to interfere in a GP’s professional and qualified judgement, especially given the high rate of successful ESA appeals, indicating just how poor the decisions issued by the DWP actually are concerning people’s capacity to work. 

Dan’s letter:

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Related

Jobcentre tells GP to stop issuing sick notes to patient assessed as ‘fit for work’ and he died.

Rogue company Unum’s profiteering hand in the government’s work, health and disability green paper

The new Work and Health Programme: government plan social experiments to “nudge” sick and disabled people into work

Tories propose nudge, big business AI initiative and ‘personal responsibility’ in place of adequate health care funding

 


I don’t make any money from my work. But you can contribute by making a donation and help me continue to research and write informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated – thank you.

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Director of medical research says rise in cases of sepsis is because of NHS funding cuts and overcrowding in hospitals

Deaths from sepsis recorded in England’s hospitals have risen by more than a third in two years, according to data collected by a leading safety expert. 

According to Sir Brian Jarman, the director of the Dr Foster research unit at Imperial College London, the number of recorded deaths where the primary cause was sepsis was 11,328 in 2014-15. By 2016-17 there were 15,722 deaths in hospital or within 30 days of discharge where sepsis was the leading cause, an increase of 38.8%.

Jarman, whose unit sends real-time alerts to hospitals that fall behind the expected mortality rate, blamed the increase partially on the consequences of real-terms funding cuts.

“The biggest thing that’s important seems to be the number of staff – doctors per bed,” he told BBC Radio 4’s Today programme in August. “One of the secondary important things is the overcrowding of hospitals. The level of overcrowding shouldn’t be more than 85% [bed occupancy], and it’s been going over 90% in recent years.”

Jarman, a former president of the British Medical Association, said the number of beds available had halved and the number of admissions had roughly doubled over the past 30 years – an “amazing change of provision of healthcare”.

In 2015, an inquiry found that 40% of patients with sepsis who arrived in A&E had not been reviewed by senior doctors quickly enough. There were also avoidable delays in giving patients intravenous antibiotics in nearly a third of cases (29%).

Every death from sepsis is a tragedy, yet too often the warning signs are missed – there is a need to get far better at spotting sepsis across the NHS and this advice shows how vital it is for clinicians to treat life-threatening symptoms as soon as possible.

Last year, Jeremy Hunt, then the health secretary, told a private memorial service for a one-year-old boy who died from sepsis that the child was let down by the NHS and the government.

Speaking at the service in Cornwall, Hunt said he had “come here to say sorry” to the family of William Mead, who died after the emergency services failed to diagnose a fatal case of sepsis. Hunt told those gathered at Truro Cathedral: “I as health secretary, the government, and the NHS, let down William.

“I’ve come here to say sorry. This weekend William should have been enjoying beautiful Cornish sunshine with his parents.

“We didn’t spot his sepsis before it was too late.”

William’s motherMelissa Mead, has become a prominent campaigner for better diagnostics of sepsis, saying that the NHS system was “broken”.

She has also described her son’s final hours, his symptoms and her repeated pleas to health services in painstaking detail on her blog site.

In February 2017, I developed sepsis, which is caused by an overly aggressive immune response to an infection. In my case, it happened because I had developed pneumonia while I had ‘flu. In sepsis (sometimes called septicaemia) the immune response causes widespread and severe inflammation and a drop in blood pressure (‘shock’), which leads to organ damage and other life threatening complications. The problem is that people often feel unwell when they have an infection, and sepsis is insidious. It can advance  very rapidly. I developed pneumonia and sepsis within four days of starting with influenza symptoms, by the fourth evening, my symptoms had become life threatening. 

I thought my symptoms were simply because I had a severe strain of influenza, and hadn’t realised I had developed pneumonia. My sons had both been very poorly the week before, while they had the ‘flu, too. By the time I knew something was very wrong, I was already in septic shock, and despite having an almost overwhelming urge to crawl back to my warm bed and just sleep, a sudden weird sense of impending doom kept me from doing so. Had I gone back to bed, I would never have woken again. 

Although Jarman believes that staff shortages and overcrowding on wards are partly to blame for the rise in sepsis, NHS England have said more conditions were being classed as sepsis than before, and a spokesperson added that efforts had also been made to improve diagnosis. However, it’s not quite true that more deaths from sepsis are being recorded as being caused by sepsis.

Dr Ron Daniels, chief executive of the UK Sepsis Trust and an intensive care consultant, said sepsis was one of the most common causes of death in the UK, it’s responsible for killing up to 44,000 people a year – in hospital and in the community.

He said that hospital records made it almost impossible to keep track of the true number of deaths through sepsis, because, he added: “It’s very common that if someone dies of sepsis that it’s coded or reported as simply being the underlying infection.

“So they might die of sepsis in an intensive care unit with multiple organ failure – but they’re recorded as a death from pneumonia. We need to fix that problem before we can truly understand the scale of sepsis.

The best way for us to do that is to develop a prospective data system like a registry that exists for other conditions, so that we can really get a national picture of what’s going on.”

He added: “The treatment for sepsis, if it’s caught early enough, involves very basic interventions – looking for the source of the infection, giving antibiotics.

“For every hour we delay in giving antibiotics, the patient’s risk of dying increases by a few per cent, so it’s essential that we spot it early and deliver the basics of care quickly.”

Jarman hopes his research data can be used to improve the survival chances of hospital patients who developed sepsis, via alerts that he sends to hospitals that are falling behind.

He said “Some of those hospitals with a lower death rate have got particular ways of reducing mortality from septicaemia, which the others we hope might learn from, and also we hope that by giving them this alert, within a month or two of the actual happening, they can actually get in there and do something quickly.”

There has been more of a focus on screening for sepsis in the NHS in recent years, led by the UK Sepsis Trust, which was formed by a group of clinicians at the Good Hope Hospital near Birmingham.

However, the fact that deaths from sepsis are commonly recorded as being caused by an underlying infection, rather than abnormal immune response to it – sepsis – means that gathering mortality data about hospital practices in diagnosis and management of sepsis is likely to lead to inaccurate results and cannot be relied on to improve recognition and diagnostic practices, or treatment.

Some reasons why sepsis is increasing

Vulnerability to sepsis is becoming more widespread. This is thought to be for a number of reasons:

  • More opportunities for infections to become complicated – more people are having invasive procedures and organ transplants, and more of us are taking immunosuppressive drugs and chemotherapies
  • Rising antibiotic resistance – microbes are becoming immune to drugs that would otherwise control infections

People more likely to get sepsis include:

  • Those with underlying lung disease, such as COPD and asthma
  • Those with illnesses that affect their immune response, such as HIV, leukaemia, chronic illness such as diabetes, lupus, and some other connective tissue /autoimmune diseases
  • Those taking immunosuppressant therapies, such as people who have had organ transplants, those with autoimmune illnesses, those with cancer having chemotherapy, or those on long-term steroid treatment 
  • Those who have had their spleen removed

Other predictors of higher severe sepsis incidence rates include socioeconomic status (those in poverty and destitution are at greater risk), and urbanicity.

In a context of austerity and cuts to basic social security and the NHS, it seems almost inevitable that cases of sepsis will increase.  

Any infection can trigger sepsis, including minor accidental cuts and insect bites that have become infected, but the following types of infections are more likely to cause sepsis:

  • Pneumonia
  • Meningitis
  • Abdominal infection 
  • Kidney/ urinary tract infection
  • Appendicitis
  • Infection of the gallbladder
  • Some cases of ‘flu

Symptoms of sepsis include:

  • Fever above 101ºF or a temperature below 96.8ºF (above 38.3º Celsius or below 36º C)
  • Heart rate higher than 90 beats per minute (tachycardia)
  • Fast, shallow breathing – rate higher than 20 breaths per minute (tachypnea)
  • Infection.

Other symptoms may be:

  • Dizziness or feelings of faintness
  • Confusion or a drop in alertness, or any other unusual change in mental state, including a feeling of doom or a real fear of death
  • Slurred speech
  • Diarrhoea, nausea, or vomiting
  • Severe muscle pain and extreme general discomfort
  • Difficulty breathing – shortness of breath
  • Low urine output (not needing to urinate for a whole day, for example)
  • Skin that is cold, clammy, and pale, blue, discolored or mottled
  • Skin that is cool and pale at the extremities, signaling poor blood supply (poor perfusion)
  • Loss of consciousness

It’s crucial to seek immediate medical attention if someone has more than one or two those symptoms, though loss of consciousness and severe breathing difficulty always need urgent medical attention.

The earlier you seek treatment, the greater are the chances of survival.

Sepsis medical criteria

There are two tools or sets of criteria that doctors use to determine the severity of your condition. One is the systemic inflammatory response syndrome (SIRS). SIRS is defined when you meet two or more of the following criteria:

  • Fever of more than 38°C (100.4°F) or less than 36°C (96.8°F), often with chills and shivering
  • Heart rate of more than 90 beats per minute (tachycardia)
  • Respiratory rate of more than 20 breaths per minute or arterial carbon dioxide tension (PaCO 2) of less than 32 mm Hg
  • Abnormal white blood cell count

Another tool is the “quick sequential organ failure assessment” (qSOFA). It uses the results of three criteria:

  • Low blood pressure
  • High respiratory rate (greater than 22 breaths per minute)
  • Glasgow coma scale score of less than 15. (This scale is used to determine your level of consciousness.)

A positive qSOFA is determined if two or more of the above measurements are abnormal. Some doctors prefer using qSOFA because unlike the SIRS criteria, qSOFA does not require laboratory tests and so may be used to make a prompt assessment. This means it can also be used by paramedics – as it was in my case. The results of either or both of these assessments will help doctors determine care promptly.

Tests, diagnosis and treatment of sepsis

The first step that doctors and paramedics take in diagnosing sepsis is to observe the symptoms. Sepsis is a major challenge to diagnose, and in Intensive Care Units it’s one of the leading causes of death. It is also a leading cause of people being readmitted to hospital. Sepsis arises unpredictably and can progress very rapidly.

When doctors observe the typical signs and symptoms of sepsis, they will also consider the patient’s medical history and be alerted to possible sepsis if there has been a recent infection, a surgical or catheter procedure, or if the patient is particularly vulnerable to infection – because of compromised immunity, for example.

The main treatment for sepsis and septic shock is antibiotics, as most cases are caused by a bacterial infection, though viral and fungal agents less commonly may also cause sepsis. If someone has severe sepsis and septic shock, antibiotics will be given directly into a vein (intravenously). Often other support is provided, such as oxygen, ventilation, or dialysis, is also given to support organ function, depending on how well a person’s organs are coping. Methods to stabilise blood pressure are often used, along with administered anticoagulants to prevent blood clots.

Ideally, antibiotic treatment should start within an hour of diagnosis to reduce the risk of serious complications or death. Intravenous antibiotics are usually replaced by tablets after two to four days (though sometimes longer). Antibiotics may have to take them for 7 to 10 days or longer, and often for a while after someone leaves hospital, depending on the severity of their condition.

Doctors may have to make a quick “best guess” at the type of infection and, therefore, the type of antibiotics needed, because speed in treating the infection is of the greatest importance; waiting for laboratory sample tests would hold up a potentially lifesaving intervention. Treatment may be adjusted once the causative microbe has been identified.

Antibiotics alone may be sufficient at a very early stage of sepsis, but treatment needs to be given very promptly.

For later stages of sepsis and septic shock, emergency hospital treatment will be needed (often in the intensive care unit); additional to the IV antibiotics, it may include:

  • Intravenous fluids (especially during the first 24 to 48 hours after admission, if you have severe sepsis or septic shock.
  • Vasopressors (to raise blood pressure)
  • Central lines
  • Anticoagulants (to prevent blood clots)
  • Other means of organ support as necessary, such as oxygen therapy, mechanical ventilation or dialysis

Severe sepsis is associated with a drop in blood pressure. Low blood pressure reduces the amount of oxygen and nutrients going to the body’s organs. This drop causes damage to the body’s major organs.

Septic shock advances when adequate blood pressure cannot be restored despite treatment with IV fluids. Septic shock may progress very quickly to multiple organ failure and death.

Complications from septic shock may cause symptoms of:

  • Kidney failure
  • Lung failure
  • Heart failure
  • Blood clots
  • Death

Prompt medical attention, diagnosis and treatment are key to surviving sepsis.

Often, paramedics may test for a rise in blood sugar as hyperglycemia is very common in people who are critically ill with sepsis, regardless of whether they have diabetes. Mine had risen despite the fact I had been unable to keep food down for four days. Mine is usually on the low side generally, but it had risen while I was ill. No one really knows why this happens. 

Laboratory tests at the hospital include a blood test to measure C-reactive protein (CRP), which is a substance in the blood that is produced by the liver, and it is used to measure levels of inflammation in the body. It’s used often to test for some types of autoimmune illness flares, too.

A CRP level of more than 10 milligrams per litre (10mg/L) indicates clinically significant inflammation. However, when someone has a severe infection such as pneumonia, it is usually very high – often between 100-200, and sometimes higher. A high CRP is generally linked with infection severity, and a CRP of 200 + is fairly common in sepsis. A CRP above 300 is associated with a poorer prognosis. Mine was 396 by the time I got to hospital. 

CRP tests are very clever science and extremely useful. It’s not possible to make a diagnosis from the test result alone, but used in conjunction with other tests, CRP results can support a diagnosis. And the CRP level may also be used to judge how effective treatments are. The CRP “resolves” – comes down quite quickly, often before a patient starts to feel better – when their treatment, such as antibiotics, is successful. Two or three days into the IV antibiotic treatment, my CRP was down to 193.

Other biochemical tests include blood clotting assessments, a white cell count, measurements of serum lactate, procalcitonin and something called alkaline phosphatase, all of which collectively may helpt to diagnose a severe infection and a severe systemic inflammatory response syndrome (SIRS), which is the key feature of sepsis

Testing is usually done to determine which family of bacteria has caused the infection so that antibiotic treatment may be tailored to treat it. 

It’s important that doctors maintain a high suspicion of sepsis  when someone hasan infection and symptoms, which is necessary to help prevent deaths.

In my case, the paramedics were highly suspicious of sepsis because I was tachycardic, my breathing was rapid, and I had an impeding sense of doom. My temperature was very raised and my blood glucose was raised. My blood pressure had plummeted to 70/40. There were no oxygen exchange noises in my lower lungs, so pneumonia was quickly diagnosed. An x ray later confirmed the pneumonia. I was given IV fluids to help raise my blood pressure and an antibiotic in the ambulance. I have no doubt these measures helped save my life.

 

Early suspicion of sepsis helps save lives.

 

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I wrote about my own experience of sepsis here, which includes more detailed information. The most shocking part ofthis experience was the fact I had not realised I was so gravely ill. So I wanted to raise awareness of this insidious and often fatal condition: Surviving sepsis: awareness raising and a case study

 


I don’t make any money from my work. I am disabled because of illness and have a very limited income. But you can help by making a donation to help me continue to research and write informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated – thank you. 

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Surviving sepsis: awareness raising and a case study

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I caught ‘flu mid-January. In the grand scheme of things, that in itself isn’t such a big deal. Thousands of people get ‘flu every year. Ordinarily, I get the ‘flu shot, but last year I somehow didn’t get around to it.

I have two sons at university who come home out of term times, and they were with me over Christmas, New Year and until their new term started mid January. On reflection, it was pretty stupid of me to neglect my ‘flu injection as students tend to come into contact with a lot of bugs, of course “Fresher’s ‘Flu” is usually almost a compulsory student experience.

I won’t ever miss my jab again, that’s for sure.

I had a pneumonia shot a couple of years back, which protects me from the most common type of pneumonia – caused by streptococcus pneumoniae – for ten years. Unfortunately, there are several different types of bacterial pneumonia, caused by various organisms.

I am considered as having a susceptibility to pneumonia, partly because I have atopic asthma. This said, once I discovered what causes my asthma flare ups – an allergy to a pet rabbit that put me in hospital a couple of times, some pollens, aerosols, fumes from bleach, amongst other things – it became much less of a problem. It tends to flare up nowadays only when I get a viral infection, such as a cold or ‘flu. 

I also have systemic lupus (SLE), which is an autoimmune illness. It means my immune system tends to attack the connective tissue and blood cells in my body. No-one understands yet why SLE starts to inflame and damage healthy cells, tissue and organs. This illness potentially affects the skin, bones, joints, tendons and ligaments, the nervous system, and all of the major organs, such as kidneys, heart, lungs, brain and so on. It often damages blood cells, too. I produce autoantibodies that attack my platelets (thrombocytopenia), which means that sometimes my blood doesn’t clot very well. And there are sometimes other blood cell abnormalities which means my immune system sometimes doesn’t do the job it’s meant to properly – fighting infection. 

I had pneumonia for the first time back in 2009. I caught a cold at work, and ended up with a chest infection and severe chest pain on one side when I breathed in. I’d been unwell with a lupus flare back then, too, but I hadn’t had a diagnosis at the time, and so didn’t know what the sudden increase in joint, tendon and nerve pain, violent headaches, cognitive problems, rashes, profound fatigue and general unwellness was.   

An x-ray at A&E showed pneumonia in my right lung, in the wall of the lower lobe, and some inflamation of the pleural membrane – that’s why it hurt to breathe in. It was a very small area that was affected (though I felt pretty horrid). I was sent home with two lots of antibiotics, pain relief and a course of steroids. My GP prescribed a third course of antibiotics a week later.  I recovered from the worst of the symptoms after a couple of weeks, though I was a little weak for a while afterwards, and was still having night sweats six weeks later. But that may well have been because of the lupus.

From ‘flu to sepsis in four days

When my son started with ‘flu symptoms, I was already rather under the weather. I’d been ill for a little while with an SLE flare and I remember hoping I didn’t come down with it myself, as it would probably wipe the floor with me. It did.

It was very nasty strain of ‘flu – not that any kind of ‘flu is particularly pleasant, of course. My youngest son started with symptoms soon after, and he was very ill, with a high fever, vomiting, diarrhoea and severe joint pain. Both boys had very nasty coughs and very sore throats. I started with symptoms a week later, despite our best efforts to try and avoid that. 

I couldn’t eat anything, and only managed to sip water. Anything else made me throw up. My fever soon turned into the teeth chattering, violently juddering kind (called “rigors”), like my younger son’s had when he first became symptomatic. I took Paracetamol to try and get the fever down, and Ibuprofen for the phenomenal joint and muscle pain and very nasty sore throat, but the medication didn’t seem to help. I stayed in bed pretty much most of the time, drifting in and out of sleep. My sons, who by then were over the worst of their symptoms, kept bringing me small amounts of food to try and entice me. I was sick if I ate anything, and couldn’t even keep a cup of tea down. I managed to sip water, and that’s all.

On the third day, my sons complained that their coughs were still hacking and very dry. I noticed that mine wasn’t. It was a severe cough, but very productive, and I wondered then if I had a chest infection. I was coughing up copious amounts of yucky stuff. By this time I was very weak, disorientated and just wanted to sleep. Looking back, I ought to have realised I was very ill, but ‘flu makes you feel very unwell, and it’s not so easy to recognise any deterioration when you are already so poorly, pretty much bedridden and sleeping most of the time. Both my sons were very lethargic, and still complaining of symptoms, but they were both up and about a bit by the fourth day of their illness.

I slept most of the fourth day, but that evening, I woke with a raging thirst. I went downstairs to get another jug of water to drink. I managed to get to the living room and was shocked at how completely breathless I was, I had to sit down. Even at rest, sitting there, I couldn’t get my breath at all.  My son told me I looked terrible and he noticed my lips were blue. I couldn’t speak properly. I just wanted to go to sleep, and my immediate and almost overwhelming urge was to simply crawl back to the comfort and warmth of my bed. It would have been very easy to have put the severe respiratory symptoms down to ‘flu. But I also had a strange and persistent sense of impending doom. Had I gone back to bed to sleep, I probably wouldn’t have woken again.

This is precisely why I felt a need to write about my experience and to hopefully raise awareness about how easily serious and life-threatening conditions like pneumonia and sepsis can arise without you recognising them, especially when you are already ill. I almost rationalised myself back into bed. However, that peculiar and pressing sense of doom didn’t ease off, and it was that which kept me from crawling back upstairs and going to sleep. 

My son rang for an ambulance. It’s a good job he did. I can remember thinking, ludicrously, that I really wasn’t well enough to face any paramedics. I just wanted to go to sleep. My mind didn’t feel like my own, my thinking felt oddly flat and somehow muffled and it was a tremendous effort. My new found friend, Mr Gutfelt Looming Catastrophe, nagged me, however, quietly setting off a distant panic alarm, informing me that something was very wrong. The word “pneumonia” suddenly crept into my thoughts. I can remember thinking that I definitely wasn’t “alright” – it crossed my mind more than once that I may not actually survive whatever it was that was wrong. They didn’t feel like my own thoughts at all. Yet I was curiously calm and detached through all of this.

By the time the ambulance crew arrived, my blood pressure was dropping and I had tachycardia (an abnormally rapid heartbeat) – which is possibly why I had the weird sense of impending doom. My temperature was still over the 39 degrees mark, despite my regular doses of Paracetamol. The paramedic also told me there were no oxygen exchange noises coming from my lower lungs. I was given a thumb prick blood sugar test and that was abnormally high – mine is usually quite low.

I was given a gram of paracetamol, and in the ambulance the paramedic put a cannula in the back of my hand and I was hooked up to IV fluids to manage the low blood pressure/ shock. I was also given an antibiotic and oxygen support, as the oxygen level in my blood was very, very low. 

At the hospital, I was seen immediately by the first of several doctors that night. There were crackles and rales heard in both lungs. My blood pressure had dropped to 70/40 despite my being given resuscitative intravenous fluids in the ambulance. I was solemnly shown each test result by each doctor as they were recorded on my file. 

I had a blood test that measured something called C-reactive protein (CRP), which is a substance in the blood that is produced by the liver, and it is used to measure levels of inflammation in the body. It’s used often to test for autoimmune illness flares, too.

A CRP level of more than 10 milligrams per litre (10mg/L) indicates clinically significant inflammation. However, when someone has pneumonia, it is usually very high – often between 100-200, and sometimes higher. A high CRP is generally linked with infection severity, and a CRP of 200 + is fairly common in sepsis. A CRP above 300 is associated with a poorer prognosis. Mine was 396. 

CRP tests are very clever science and extremely useful. It’s not possible to make a diagnosis from the test result alone, but used in conjunction with other tests, CRP results can support a diagnosis. And the CRP level may also be used to judge how effective treatments are. The CRP “resolves” – comes down quite quickly, often before a patient starts to feel better – when their treatment, such as antibiotics, is successful. Two days into the IV antibiotic treatment, my CRP was 193.

I had already seen that it had been written on my notes “sepsis very likely.” The chest x-ray showed a consolidation in the right lung, mid zone, some haze and infiltrate also on the lower left; opacification in both lungs. Consolidation is often seen with acute infectious pneumonia in the middle to late stages. It shows up as white, opaque patches on an x-ray. 

I was diagnosed with bilateral “Community Acquired Pneumonia” (CAP).  I had many other biochemical tests, such as blood clotting assessments, a white cell count, measurements of serum lactate, procalcitonin and something called alkaline phosphatase, all of which collectively indicated a severe infection and a severe systemic inflammatory response syndrome (SIRS). My potassium and other salts were very low, my blood proteins were abnormal.

My usually low blood sugar was rising, despite my not having eaten for four days. I had to have an arterial blood gas test, which I always dread – I have had those a few times before during severe asthma attacks – but for once it was remarkably painless. This test measures the acidity and the levels of oxygen and carbon dioxide in the blood from an artery (usually in the wrist just under the thumb). It is used to check how well your lungs are able to move oxygen into your blood and remove carbon dioxide from your blood.

My heart was also monitored with an electrocardiogram machine. 

The causative infectious agent was found to be Staphylococcus aureus, but luckily, I tested negative for the methicillin-resistant (MRSA) strain. I had a throat swab that later confirmed I had type A H3N2 influenza, which is known to be a severe strain.

I was admitted to hospital, prescribed Tamiflu, IV administered antibiotics – Piperacillin, Tazobactam and slow intravenous injections of Co-amoxiclav. I was also given Enoxaparin injections, which prevent blood clots – often a risk with septic shock – and other treatments, such as potassium (blood tests showed my electrolytes were very low), and fluids to treat the low blood pressure, via the drip. I was also prescribed a course of steroids to treat the inflammation and help bring the lupus flare under control after the IV treatments were completed.

When the IV treatment was concluded, I continued to take oral antibiotics for a couple of weeks, and the steroids, which were eventually tapered off.

I saw a rheumatologist whilst I was in A&E, among several other doctors. I remember she was very blunt and told me I was “seriously ill”. The SLE was considered a “comorbid” condition, which made things more complex because comorbidities can lead to further complications. It was also important to consider differential diagnoses, as lupus can cause lung injury, too. It can lead to pneumonitis and other problems.

However, the recent history of influenza, blood tests and x-rays pointed to infectious pneumonia. It was thought that the SLE was why I had got so ill with the ‘flu and pneumonia in the first place. One of the treatments for my SLE was methotrexate – a chemotherapy which is an immunosuppressant – it lowers people’s immunity – and that, in addition to the illness, has also placed me at increased risk of serious infections.

I was put in a room on my own – because I had ‘flu, it was a sensible infection control measure – where I was given around the clock care. The first couple of days in hospital are very hazy, I had a lot more tests to monitor how my body was coping. I slept a lot and I also had hallucinations. I think it may have been because of one of the antibiotic treatments causing side effects, but I was also very ill, so it’s difficult to say for sure. I can remember feeling that everything was somehow very “thin” and fragile  – none of my thoughts seem to have any familiarity, reliability, purpose, substance or meaning. I had some very strange and vivid dreams, too. I lost all sense of time and felt like I wasn’t really “there”. I wasn’t myself, that’s for sure.

My oxygen mask slipped off a few times when I slept, and my blood oxygen levels fell as a result – that can cause confusion and changes in mental status, too. I couldn’t use the usual nasal cannula and tube type of oxygen delivery, which is a bit more secure, because my nose was very sore due to blistering, so I had to use a mask. Lupus often causes painful blistering in the nose and mouth.  

I was given continuous oxygen support for the first four or five days. Once the IV treatments were completed, I felt better. I even managed a small amount to eat by the fourth day. Everything I tried to eat tasted and smelled of burnt bourbon biscuits, for some inexplicable reason. My sense of taste had taken a turn for the weird. And the antibiotics really upset my stomach. 

After five days I was moved to the respiratory ward. The throat swab results had been chased up the day before, and as I had tested positive for type A influenza, I was put in a room that was separate from the main ward again, as an infection control measure. I was also started on a course of Tamiflu, which was rather late in the day for me in terms of managing symptoms and complications, but it was a sensible infection control measure in a hospital, and especially on a respiratory ward. 

I’ve made a note for future reference: Tamiflu can be prescribed by your GP if you are considered at risk of pneumonia and you come into contact with someone who has ‘flu. 

Once I came home from hospital, I continued to take two lots of antibiotics (Co-amoxiclav and Clarithromycin) and steroids (Prednisolone) for a couple of weeks. I finished the course of Tamiflu and my GP was asked to check my ‘flu symptoms had gone. I also have to use my steroid inhaler to manage my asthma.

I have had follow up appointments with a pulmonary consultant and my rheumatologist. I had a lung scan last week to see if the opacification on my lungs has cleared. My consultant is concerned that there’s a possibility I may have pulmonary fibrosis – it is sometimes a complication of connective tissue diseases like lupus and it’s also a known side-effect of a treatment I have had – Methotrexate – unfortunately. I’ve had some lung function tests this week, and have some further tests next week. My lung specialist told me that it’s likely to take at least three months to physically recover fully from my pneumonia and sepsis.

The standard of medical care and support I have received from the paramedics, A&E staff, Acute Medicine doctors, ward staff, and my consultants has been outstanding. The hospital staff were redirecting some patients to another regional hospital because they were so busy on the night I was admitted, and had said they were only seeing people with very serious medical conditions – such as a stroke or heart attack – and those needing very urgent care. Yet I was seen by a doctor immediately when we arrived at the A&E. Very prompt recognition and treatment of my condition by the paramedics and A&E doctors undoubtedly saved my life. 

Recognising sepsis

Sepsis is a life-threatening illness caused by your body’s response to an infection. Your immune system protects you from many illnesses and infections, but it’s also possible for it to overreact, launching a disproportionately aggressive response to an infection and causing inflammation and damage to your body. 

The first signs and symptoms of sepsis are often subtle and can be mistaken for those of other serious conditions, and the symptoms may also rapidly advance, as they did in my case.

So, my sepsis developed when the chemicals that my immune system released into my bloodstream to fight the lung infection cause overwhelming inflammation throughout my entire body instead, which potentially could have led to organ damage. Sepsis can very quickly lead to septic shock.

Though my blood pressure had dropped a lot, it didn’t drop critically low – below 65 mm hg (systolic pressure) – and was eventually stabilised with IV administered fluids. I was very lucky. 

Sepsis (sometimes called septicemia) is always a medical emergency.

Vulnerability to sepsis is becoming more widespread. This is thought to be for a number of reasons:

  • More opportunities for infections to become complicated – more people are having invasive procedures and organ transplants, and more of us are taking immunosuppressive drugs and chemotherapies
  • Rising antibiotic resistance – microbes are becoming immune to drugs that would otherwise control infections

People more likely to get sepsis include:

  • Those with underlying lung disease, such as COPD and asthma
  • Those with illnesses that affect their immune response, such as HIV, leukaemia, chronic illness such as diabetes, lupus, some other connective tissue diseases
  • Those taking immunosuppressant therapies, such as people who have had organ transplants, those with autoimmune illnesses, those with cancer having chemotherapy, or those on long-term steroid treatment 
  • Those who have had their spleen removed

Other predictors of higher severe sepsis incidence rates have included socioeconomic status (those in poverty and destitution are at greater risk), and urbanicity.

Any infection can trigger sepsis, but the following types of infections are more likely to cause sepsis:

  • Pneumonia
  • Meningitis
  • Abdominal infection 
  • Kidney/ urinary tract infection
  • Appendicitis
  • Infection of the gallbladder
  • Some cases of ‘flu

 Symptoms of sepsis include:

  • Fever above 101ºF or a temperature below 96.8ºF (above 38.3º Celsius or below 36º C)
  • Heart rate higher than 90 beats per minute (tachycardia)
  • Fast, shallow breathing – rate higher than 20 breaths per minute (tachypnea)
  • Infection.

Other possible symptoms may be:

  • Dizziness or feelings of faintness
  • Confusion or a drop in alertness, or any other unusual change in mental state, including a feeling of doom or a real fear of death
  • Slurred speech
  • Diarrhoea, nausea, or vomiting
  • Severe muscle pain and extreme general discomfort
  • Difficulty breathing – shortness of breath
  • Low urine output (not needing to urinate for a whole day, for example)
  • Skin that is cold, clammy, and pale, blue, discolored or mottled
  • Skin that is cool and pale at the extremities, signaling poor blood supply (poor perfusion)
  • Loss of consciousness

It’s very important to seek immediate medical attention if you have more than one or two those symptoms, though loss of consciousness and severe breathing difficulty always need urgent medical attention.

The earlier you seek treatment, the greater your chances of survival.

Sepsis medical criteria

There are two tools or sets of criteria that doctors use to determine the severity of your condition. One is the systemic inflammatory response syndrome (SIRS). SIRS is defined when you meet two or more of the following criteria:

  • Fever of more than 38°C (100.4°F) or less than 36°C (96.8°F), often with chills and shivering
  • Heart rate of more than 90 beats per minute (tachycardia)
  • Respiratory rate of more than 20 breaths per minute or arterial carbon dioxide tension (PaCO 2) of less than 32 mm Hg
  • Abnormal white blood cell count

Another tool is the “quick sequential organ failure assessment” (qSOFA). It uses the results of three criteria:

  • Low blood pressure
  • High respiratory rate (greater than 22 breaths per minute)
  • Glasgow coma scale score of less than 15. (This scale is used to determine your level of consciousness.)

A positive qSOFA is determined if two or more of the above measurements are abnormal. Some doctors prefer using qSOFA because unlike the SIRS criteria, qSOFA does not require laboratory tests and so may be used to make a prompt assessment. This means it can also be used by paramedics – as it was in my case. The results of either or both of these assessments will help your doctor determine care promptly.

Tests, diagnosis and treatment of sepsis

The first step that doctors and paramedics take in diagnosing sepsis is to observe the symptoms. Sepsis is a major challenge to diagnose, and in Intensive Care Units it’s one of the leading causes of death. It is also a leading cause of people being readmitted to hospital. Sepsis arises unpredictably and can progress very rapidly.

When doctors observe the typical signs and symptoms of sepsis, they will also consider the patient’s medical history and be alerted to possible sepsis if there has been a recent infection, a surgical or catheter procedure, or if the patient is particularly vulnerable to infection – because of compromised immunity, for example.

Biochemical tests include blood cultures, white blood cell count and C-reactive protein (CRP), procalcitonin and lactase, alkaline phosphatase, platelet count and other blood clotting tests, electrolyte measurement (levels of salts such as potassium and sodium), glucose measurement, protein, creatinine and urea measurements, amongst several others. 

The main treatment for sepsis and septic shock is antibiotics, as most cases are caused by a bacterial infection, though viral and fungal agents less commonly may also cause sepsis. If you have severe sepsis and septic shock, antibiotics will be given directly into a vein (intravenously). Ideally, antibiotic treatment should start within an hour of diagnosis to reduce the risk of serious complications or death. Intravenous antibiotics are usually replaced by tablets after two to four days (though sometimes longer). You may have to take them for 7 to 10 days or longer, and often for a while after you leave hospital, depending on the severity of your condition.

Doctors may have to make a quick “best guess” at the type of infection and, therefore, the type of antibiotics needed, because speed in treating the infection is of the greatest importance; waiting for laboratory sample tests would hold up a potentially lifesaving intervention. Treatment may be adjusted once the causative microbe has been identified.

Antibiotics alone may be sufficient at a very early stage of sepsis, but treatment needs to be given very promptly.

For later stages of sepsis and septic shock, emergency hospital treatment will be needed (often in the intensive care unit); additional to the IV antibiotics, it may include:

  • Intravenous fluids (especially during the first 24 to 48 hours after admission, if you have severe sepsis or septic shock.
  • Vasopressors (to raise blood pressure)
  • Central lines
  • Anticoagulants (to prevent blood clots)
  • Other means of organ support as necessary, such as oxygen therapy, mechanical ventilation or dialysis

Severe sepsis is associated with a drop in blood pressure. Low blood pressure reduces the amount of oxygen and nutrients going to the body’s organs. This drop causes damage to the body’s major organs.

Septic shock advances when adequate blood pressure cannot be restored despite treatment with IV fluids. Septic shock may progress very quickly to multiple organ failure and death.

Symptoms of septic shock include:

  • Fever, which may be followed by a drop in body temperature to below normal
  • Warm, flushed skin
  • Chills
  • Rapid, pounding heartbeat
  • Rapid breathing or trouble breathing
  • Confusion
  • Reduced alertness
  • Irregular blood pressure
  • Reduced urination
  • Rash – some people develop a reddish discolouration or small dark red dots over the body
  • Severe bleeding – “disseminated intravascular coagulation”

Complications from septic shock may cause symptoms of:

  • Kidney failure
  • Lung failure
  • Heart failure
  • Blood clots

Prompt medical attention, diagnosis and treatment are key to surviving sepsis.

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Further information

Post-sepsis syndrome

Not everyone experiences problems after being critically ill and the length and severity of the sepsis and the fitness of the individual prior to their illness has a marked impact on how quickly they recover. Post-sepsis syndrome is a condition that affects up to 50% of sepsis survivors.

Some problems that may arise can be physical and/or psychological. 

Physical:

  • Lethargy / excessive tiredness
  • Poor mobility / muscle weakness
  • Breathlessness / chest pains
  • Swollen limbs (excessive fluid in the tissues)
  • Joint pains
  • Insomnia (due to pain / breathlessness)
  • Hair loss
  • Dry / flaking skin and nails
  • Taste changes
  • Poor appetite
  • Changes in vision
  • Changes in sensation in limbs
  • Repeated infections (a small percentage of sepsis survivors suffer recurring infections during their rehabilitation.) 

Psychological and emotional:

  • Anxiety / fear of sepsis recurring
  • Depression
  • Flashbacks
  • Nightmares
  • Insomnia (due to stress or anxiety)
  • PTSD (Post Traumatic Stress Disorder)
  • Poor concentration
  • Short term memory loss

And in older people: “…60 percent of hospitalizations for severe sepsis were associated with worsened cognitive and physical function among surviving older adults. The odds of acquiring moderate to severe cognitive impairment were 3.3 times higher following an episode of sepsis than for other hospitalizations.”

Don’t suffer in silence. If you experience any of these problems during your recovery, see your GP and ask for support.

Related:

Recovery from Sepsis

Post-sepsis syndrome 

Sepsis and Autoimmune Diseases


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