Dr Michelle O'Driscoll: Don't be afraid to ask, 'could it be sepsis'? 

Approximately 13,000 cases of sepsis are diagnosed in Irish hospitals annually.

Most of us have heard stories of sepsis and its sometimes tragic outcomes, with 1 in 5 of those who develop sepsis subsequently dying from it.

However, what sepsis is, how to recognise it and what to expect in its treatment and recovery journey is not widely understood, with 39% of adults in a recent survey not knowing its signs or symptoms.

As we go through life, we all battle different bacterial, viral and fungal infections and rely on our immune systems and/or medical treatments to overcome them. Usually this happens effectively, without any particular issue occurring.

Sepsis is a complication of an infection however, that leads to it taking over multiple organs or even the whole body. If not caught and treated early and effectively, it can lead to potential organ failure and death. It is therefore a medical emergency if suspected, and should be treated as such.

Sepsis can affect people of any age. Babies may develop it, as can children, adults, and the elderly. The location of the infection can begin anywhere, with lung, urinary tract and stomach being the most common sites for it to start. Wounds can also get infected and become the entry point for infection.

Knowing what sepsis symptoms to watch out for is so important for early detection and effective treatment, but this can be challenging as symptoms of sepsis are actually quite vague and can seem similar to things like flu or meningitis.

In adults and older children, a temperature of above 38 or below 36 degrees celsius may be present, potentially accompanied by chills, breathing changes, vomiting, headache, feeling or acting differently such as confusion or exhaustion.

The HSE’s helpful acronym SEPSIS can be applied:

• S Slurred speech, new confusion, too sick to communicate, drowsiness;
• E Extreme shivering, muscle aches, fever;
• P Has not passed urine in the last 12 hours and does not feel like passing urine;
• S Shortness of breath, lips tinged with blue, feels like your heart is racing, dizzy when you sit or stand;
• I I feel like I’m going to die;
• S Skin mottled and discoloured, new rash that is still visible when pressed on with a clear glass (glass test)

In younger babies, their feeding and drinking can be affected, and their skin may be mottled. They may be less responsive, irritable, have sunken eyes, or be vomiting repeatedly. Having no urine output, feeling cold to the touch, or a non-blanching rash can all also indicate sepsis.

Unfortunately, many of us are not confident in how to act in a case of suspected sepsis. A good rule of thumb, regardless of age, is to make sure to present for examination as soon as possible if you or somebody you’re caring for is not themselves, and you have cause for concern.

Time is of the essence with suspected sepsis, so acting quickly is really important.

It may end up being nothing to worry about, but don’t delay, and don’t hesitate to ask the question, “could it be sepsis?”

A GP would refer immediately to the hospital if they suspect sepsis. Deterioration can happen very quickly, so flagging any suspicion of sepsis helps other healthcare professionals to follow through on this in the hospital.

Treatment for sepsis would include antibiotics, IV fluids, oxygen, and any organ support if required. Tests and scans will help to determine the cause of the sepsis and the effectiveness of the treatments being tried. Septic shock can occur when blood pressure drops to a level where the organs aren’t getting enough circulation.

For recovery after sepsis, it can take time to return to full health. This can be quite a long period of months or even years, which shouldn’t be underestimated. The psychological impact of sepsis should also be considered, as it can be a traumatic experience for the patient and their carers also, warranting support to debrief and process it. It’s also important to note the increased potential risk of returning sepsis if you’ve had sepsis before, particularly within the first year. This risk then decreases to lower levels.

Sepsis, unfortunately, isn’t always preventable, and can happen even when doing all the right things. The types of actions that we can all take generally to support good health include awareness of diet and lifestyle, being up to date on our vaccinations, completing the courses of any prescribed antibiotics for existing infections, washing hands regularly and keeping any wounds clean.

Sepsis can be life-threatening, so early symptom recognition and quick action is key to a successful outcome.

Asking the question “could this be sepsis?” may plant the seed for identifying it sooner, and getting important treatment started promptly.