Ask Us Anything About… Sepsis

Description – The video begins inside a conference room at Penn State Health Milton S. Hershey Medical Center. Two people are standing next to each other. Standing from left to right is Dr. Steven Moore and Scott Gilbert.

Scott Gilbert – From Penn State Health, this is “Ask Us Anything About Sepsis,” I’m Scott Gilbert. Sepsis happens when your immune system struggles to fight off infections. In the worst cases, it can actually lead to a life-threatening drop in blood pressure often referred to as septic shock and even failure of several organs. Bacterial infections are most often to blame but sepsis can also result from other infections, even some as minor as a scraped knee. We’re going to learn more today from Dr. Steven Moore. He’s an emergency and critical care physician here at Penn State Health Milton S. Hershey Medical Center. Dr. Moore, I appreciate your time today. Let’s start nice and general, just tells us a bit about what sepsis is because I have a feeling it’s something people may not really know what it is until it affects them or someone they know.

Dr. Steven Moore –  Thank you. So sepsis is a body’s reaction to an infection. So, usually, it’s an infection by a bacteria but it can often be a virus or even a fungal infection. The body then has almost an overreaction to the infection, leading to substantial drops in your blood pressure. It leads to confusion or changes in what we call their mental status and often fevers, elevated what we call white blood cell count. All of these things lead to an increased risk of death in these patients so it is vitally important that we see them early in the emergency department and treat them.

Scott Gilbert – Are there particular types of infections or infections in certain parts of the body that most often could lead to sepsis?

Dr. Steven Moore –  So, most commonly, we see infections in the lung as our primary cause of sepsis, so pneumonias are a very big cause. But anything from during flu season, the flu virus causing it, infections building up under the skin such as abscesses can cause this or even infections in the abdomen. So there’s a wide range of patients that can be affected by this so we have to be very vigilant to make sure we can catch all those people.

Scott Gilbert – I think you touched on this a little bit already but who’s at the highest risk of developing sepsis?

Dr. Steven Moore –  So elderly patients, patients who are immunosuppressed or don’t have an actively functioning immune system, patients that are very young, patients that have not been appropriately vaccinated, those are probably the big groups that fall in our encatchment [phonetic]. But anybody can get sepsis at any age.

Scott Gilbert – You’re watching “Ask Us Anything About Sepsis” from Penn State Health and we invite you to do just that by putting your comments and your questions in the comment field below this Facebook post and we will pose them to Dr. Steven Moore. He’s an emergency and critical care physician here at the Milton S. Hershey Medical Center. And we’re talking about a range of different types of conditions and infections that can lead to sepsis but the inverse is not true. That is, not every infection is going to necessarily lead to sepsis.

Dr. Steven Moore –  Yeah, fortunately, our body, most of the time, does a great job fighting off these infections but every once in a while for reasons that we don’t always understand the body has this over-exaggerated response to bacteria getting into our blood or growing within somewhere in our body and, at that point, you develop what’s called sepsis. If the syndrome goes untreated, it progresses to what’s now known as septic shock. That’s where your blood lactate — that’s a very common thing you may hear — becomes elevated. We say the number four is really the substantial number where things are going really the wrong way. And the other thing is a dropping in blood pressure and that leads to your vital organs not getting enough oxygen or perfusion, so you get organ dysfunction, which is another word you’ll hear very commonly with sepsis.

Scott Gilbert – So, obviously, sepsis and septic shock, they’re not interchangeable. Septic shock is the more severe condition and can more easily lead even to death.

Dr. Steven Moore –  Absolutely. So sepsis is kind of a blanket term. Septic shock falls within it and it’s like a spectrum disorder. You have everything from a very mild response that just shows tachycardia, fevers but has a low risk for death all the way up until what we call shock but any type of sepsis needs early identification and appropriate treatment with antibiotics and that prevents that progression.

Scott Gilbert – So I think at some point it’s probably safe to say we all suffer infections. Our body’s always trying to fight off some kind of infection it seems. What could cause someone to reasonably think I might actually have sepsis or maybe I should talk to a physician about this particular infection that’s kind of taken a strange turn?

Dr. Steven Moore –  You know, the symptoms that you’ll experience, everybody’s going to be different based on the organ system that’s involved but the big ones we really concern ourselves with are the really shaking chills, confusion, not really — just feeling very, very sick, you know, much worse than you have before. At that point in time, it’s appropriate to contact a healthcare provider or come to the emergency department and get checked out.

Scott Gilbert – And it actually, like you said, there’s a change of mental state there, right?

Dr. Steven Moore –  Absolutely. So this is one of the symptoms that we find is really important, sepsis, and one of the issues is is that sepsis can sometimes be a masquerader. It can look like a lot of different things, so we have to be very vigilant to try to find it and treat it very early because that has been shown through many studies to be the most important thing we can do.

Scott Gilbert – We welcome your questions for Dr. Steven Moore, an emergency and critical care physician here at the Milton S. Hershey Medical Center. Just put them in the comment field below this Facebook post. Even if you’re watching it in archived form on playback, we can still track down some answers for you. We have a question now from Linda who’s asking, can this happen to healthy children or adults?

Dr. Steven Moore –  Absolutely. Healthy children and adults can both get sepsis, children especially from bacterial infections and they’ll show a lot of what we call the classic signs of sepsis where they’ll get very febrile. They’ll have very high fevers. They’ll have the change in their behavior. They won’t be as awake. They won’t be as alert for you. And they can have very late changes in blood pressure but their heart rate will start climbing very early. Healthy adults do a very similar thing, usually not such a robust fever but will have that changing in that mental status, will just feel much worse due to the cytokines as we call them, our inflammatory proteins in the body that cause this kind of response. So it’s really important that they just get to the hospital early to get treatment.

Scott Gilbert – And sepsis can specifically occur in pregnant women, what causes that usually?

Dr. Steven Moore –  There’s a whole host of things that can cause it. Pregnancy in and of itself does cause an immunosuppressed state for the patient. So they can have flu that can cause a bad sepsis, which is why it’s so important that they get a flu shot during pregnancy and that those who are going to be around them have them. They can also have it from complications within pregnancy or even during the delivery period. So it’s another group that we must be vigilant with. And when they spike fevers, they really need truly evaluated to make sure that they aren’t developing something like sepsis.

Scott Gilbert – You’re talking about a real range of symptoms here and especially with those advanced symptoms and septic shock, that leads me to believe catching it early must be very important.

Dr. Steven Moore –  Yeah. So there were some pioneering studies, really in the early 2000’s, where they discovered that catching these patients in the emergency department where over 80% of all our cases of sepsis happen, catching it there and initiating our treatments there has really been a game changer as far as reducing mortality.

Scott Gilbert – And we also said in the intro that sepsis can result from something as simple as a scraped knee. We don’t want to scare people because I think we all suffer scraped knees from time to time, but what’s the way that that can snowball into something like this?

Dr. Steven Moore –  Anytime you get a breakdown in the normal skin, bacteria can get inside the skin. Most of the time we fight that off, no problem. But when it gets big, red, swollen and you see the spreading redness around the leg, then you’ve got to think that that’s an overwhelming infection and not just your kind of common scraped knee and that’s where the sepsis comes from is allowing the bacteria to get in and allowing it to get into the bloodstream.

Scott Gilbert – You’re watching “Ask Us Anything About Sepsis” from Penn State Health. We welcome your questions for Dr. Steven Moore. He’s an emergency and critical care physician here at Hershey Medical Center. So add those questions in the comment field below this Facebook post. And if you find this information useful as of course we hope you do, we hope you’ll also share it on your Facebook page to help the info reach more people. A question now from Michelle who’s asking, because she’s had sepsis, does she have a better chance of getting it again?

Dr. Steven Moore –  So that’s an interesting question. So immediately after someone has sepsis, there’s actually a period where we’ve figured out that the immune system gets so turned down that they actually are at risk in that very short period of getting another infection. However, in the long term, it’s not really a risk factor. It’s kind of a little more complicated than that. Some patients who have gotten sepsis before from, say, urinary tract infections and have what we call colonization or kind of bad bacteria that live in their bladder are going to be at risk again if they have any kind of change in their immune status to get another infection that could lead to sepsis. So certainly, when we hear that someone’s had sepsis before, we are ever vigilant with them. But fortunately, there’s no direct correlation to say that if you’ve had sepsis before you’re going to have sepsis again.

Scott Gilbert – From early-stage sepsis to later-stage or even septic shock, walk us through some of the more common treatments. I imagine medication’s obviously involved.

Dr. Steven Moore –  Yeah. So there’s actually a protocolized treatment for sepsis and septic shock, first of which, we need to get blood work so that we can measure the white blood cells in their body. Also, we get what are called blood cultures. That’s where we take blood samples so that we can test them for bacterias, viruses, different things, funguses. Then, the next up is really initiation of treatment early and that’s with what we call broad-spectrum antibiotics. And we’re trying to treat as many different bacteria because, early on, we don’t always know what is causing their infection. So the important part is to try to treat that bug. Later, when we figure out what exactly it is, we can narrow down those antibiotics to what specifically will treat it. The third component of that therapy is fluids. So if somebody has low blood pressure or what we call rising lactate, then we need to treat them with a fluid bolus in order to stabilize their blood pressure. If they continue to progress from there, we talk about using what are called vasoactive medications which will help support the blood pressure and support them through the illness and allow the antibiotics to work to treat the infection.

Scott Gilbert – Is there ever a procedure to try to remove some of the infection?

Dr. Steven Moore –  Absolutely. So source control is paramount. So if, say, they have an infection built up in their kidney, they may need a tube placed in to drain that infection from the kidney. If they have an infection in their gallbladder, the gallbladder has got to either get drained or come out. So until you can get control of the infection, you can’t really treat sepsis. So if it is a bloodstream infection, that control is simply antibiotics. But if it is a localized infection or like an abscess, then that needs drained or removed from the body.

Scott Gilbert – Okay. And something you mentioned earlier on was white blood cell count and we’ve heard that term — anybody who’s had blood work has probably heard that term, but can you talk briefly about what that is and why that’s an important indicator for this?

Dr. Steven Moore – So the white blood cells are the infection-fighting cells in body. And so when there is an acute infection like sepsis, that number can actually either go up or actually go down in some cases. And when it goes down, that’s actually when the more severe infection’s going on. So that’s another marker for us to test the blood to say, oh boy, their white count is elevated, I should really be thinking about sepsis at this point. Or oh boy, that white count has gone really low. I should be worried that they’re not mounting an adequate response to this infection and this could be sepsis.

Scott Gilbert – An important diagnostic tool. Again, we welcome your questions for Dr. Steven Moore. Looks like Alan has one. He’s asking, why do people get sepsis in hospitals?

Dr. Steven Moore –  So sepsis in hospitals is actually a pretty rare phenomenon. Most people show up to the hospital with sepsis. It’s about 80 — even sometimes, some months as we check, 90% of all cases of sepsis occur outside of the hospital, come into the emergency department, are identified, and then go upstairs for their treatment. A very small percentage of people do develop sepsis after being in the hospital. The hospitals actually go through a rigorous process of reducing hospital-acquired infections with everything from putting the gowns on people when they go into patient’s rooms who have potentially infectious diseases to checking IV sites and making sure those don’t have any signs of infection to making sure that we don’t leave things like Foley catheters in bladders that increase people’s risk of infection. It’s become a very important part of treatment of sepsis is prevention.

Scott Gilbert – And I imagine there’s a lot of training that goes into it for people like you, for nurses, for others here in the medical setting, so I imagine that’s probably a rather broad-reaching set of training modules.

Dr. Steven Moore –  Absolutely. There is — every aspect of allied health is responsible for preventing infection. Everybody has their own task on it but we all come together to work to reduce the number of hospital-related infections from either catheters being in place, what we call Foleys or the catheters in bladders, breathing tubes in place, all those things. We do everything we can to reduce the number of days those are in place and to continue to readdress their need.

Scott Gilbert – All right. We have another question now from Jerry. He’s asking if sepsis is contagious and whether it can spread to other people.

Dr. Steven Moore –  So most sepsis is not but that’s with a caveat. So it depends on the cause of sepsis. So if the causes of sepsis is something like flu or influenza, yes, that is contagious and that’s something that we, you know, place masks on people who are going to be in to see the patient and vice versa. Maybe keep a mask on the patient when they’re in areas where they may be in contact with other patients. So meningitis is another example of one that can be contagious. But if it’s a bloodstream infection causing sepsis, generally, no not contagious. But again, it’s going to depend on the type of sepsis going on.

Scott Gilbert – Okay. And you talked a lot about how medical professionals work to prevent sepsis. Is there anything else that people should know in general about steps they can take to prevent sepsis since, as you said, 80 to 90% of people come into the hospital having already reached that point?

Dr. Steven Moore –  You know, vaccination, your handwashing cleanliness. If you’re sick, stay at home so that you avoid spread of communicable disease. Those are probably the biggest things you can do. But once sepsis has onset, the biggest thing is getting to the emergency department so you can be evaluated and treated appropriately before it gets to somewhere where it’s — the septic shock area and that’s really when the death rate really rises.

Scott Gilbert – All right. Good information and important information for people to know. Dr. Steven Moore, thanks so much for your time today.

Dr. Steven Moore –  Thank you.

Scott Gilbert – All right. And thank you very much for watching “Ask Us Anything About Sepsis” from Penn State Health.