Sepsis

Sepsis

Sepsis is not as well known as it could be, considering it is a serious and life threatening condition which if not recognised and treated can lead to death or long-term physical/mental effects in a patient.

Sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs (Czura, 2011)

Sepsis in layman’s terms is organ failure caused by the body over-reacting to an infection. Really, it should be thought of as an ‘ infection attack’  and given the same seriousness in terms of potential mortality and speed of treatment needed as a heart attack or ‘brain attack’ (stroke).

How Sepsis escalates:

  1. Infection is a pathogen affecting the body
  2. Sepsis is the body’s over-reaction to fighting the infection, causing organ failure
  3. Septic shock is impaired blood supply to organs caused by low blood pressure

 

How to tell if a patient has Sepsis?

Sepsis is scary in it’s ability to escalate and cause sudden death in otherwise previously healthy patients. We all know the signs of stroke  (FAST) and heart attack, but how do you know if someone has Sepsis?

Clinical observations (‘Obs‘) signs are::

  • Low Blood Pressure (below 110 systolic- usual BP is 120/80 and systolic is the top number)
  • Fast breathing (increased Respiratory Rate, over 20 breaths/minute)

Other factors

  • Confusion (altered mental state eg slow to process information)
  • No urine output for 12hrs+
  • Shaking episodes or the cold shivers/cold sweats (feeling cold/shivering but with high temp & sweating; officially called Rigors)
  • ‘Feeling of doom’ reported by patient, often causing anxiety*
  • In a risky category:  chemotherapy, diabetes, sickle cell, recent surgery/pregnancy/termination, long term steroids, IV drug user, the very young or old, open skin wounds

If you think someone has Sepsis because they display any of the above together with an infection, it is an emergency and you should call 999/escalate to a senior in the same way you would if you suspected a stroke or TIA, and use the word SEPSIS. 70% of cases happen in the community- if the patient is in the community they should have a blue-light ambulance to hospital.

Do NOT say ‘Something’s not right they look really unwell, can you take a look?’ or ‘I think their infection’s getting worse’

Do say  “They have potential SEPSIS.”

When someone goes into septic shock, their chance of dying increases by 7.5% each hour treatment isn’t started.

 

Survivors of Sepsis often have long term mental and physical effects such as fatigue, reduced mobility, PTSD. It can take 18 months to get fully back to their previous function.

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*The ‘sense of impending doom’ is actually a medical term for a symptom, and the unpleasant physiological feeling is caused by the body’s unconscious processes which we have no control over (such as breathing, heart rate, digestion …things controlled by the sympathetic nervous system) being affected.  People suffering things like heart attacks also report this feeling of dread or doom.

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Resources

Czura C. J. (2011). “Merinoff symposium 2010: sepsis”-speaking with one voice. Molecular medicine (Cambridge, Mass.), 17(1-2), 2-3. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022986/ [accessed on 22.02.19]

NICE guidelines https://www.nice.org.uk/guidance/ng51/resources

https://www.nice.org.uk/guidance/ng51/resources/algorithm-for-managing-suspected-sepsis-in-adults-and-young-people-aged-18-years-and-over-outside-an-acute-hospital-setting-pdf-2551485716

Sepsis UK https://www.e-lfh.org.uk/wp-content/uploads/2018/02/Sepsis_Manual_2017_final_v7.pdf

Sepsis Trust https://sepsistrust.org/

Trust Me I’m A Doctor BBC programme https://www.bbc.co.uk/programmes/articles/1JKdvV3tP67FxzY1gKRNbvw/what-is-sepsis-and-how-can-i-spot-it

If you’re employed in NHS, you can complete the ‘Sepsis in Primary Care’ e-learning module via your ESR account.

 

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Article review: “A qualitative study of views on disability and expectations from community rehabilitation service users” by Kulnik & Nikoletou (2017)

Article review: “A qualitative study of views on disability and expectations from community rehabilitation service users” by Kulnik & Nikoletou (2017)

In this study Kulnik and Nikoletou (2017) discuss two opposing ways of viewing disability- the social model of disability and the individual-medical model. The former sees the restrictions of the environment and society as the barrier to performance, whereas the latter regards the physical impairments of the person as causing the limitations in performance.

otter-on-crutches

They propose that whichever model a therapist most aligns with will shape the treatment they provide, through the clinical reasoning and goals they set encourage the client to set. From interviews with disabled clients, they found four key themes. These were

  1. talking about the term ‘disability’
    • clients were uncomfortable using the label of disabled, and described the term in a third person way rather than as relevant to themselves
    • it was described as… the inability to do things for yourself and therefore reliance on others
    • clients’ views of disability aligned with the individual-medical model
  2. experience of disability and ageing
    • these were generally viewed as frightening and negative experiences
  3. difficulties with the social model way of thinking
    • clients did not interpret their situation in a political/social model way
    • they often viewed health professionals as acting out of self-interest and not helping the disabled people they are meant to serve
    • they described inadequate resources and systems (eg adaptive equipment and reductions in personal care assistance) as making their disabled situation worse
  4. expectations of clients from community rehab programs
    • clients had limited general knowledge of what to expect from community rehab, and any knowledge was based on previous personal experience
    • rehabilitation was associated with institutional settings

Factors influencing these themes are that the government is shifting towards the client being an empowered consumer rather than a passive patient, in which case community rehab (including any OT services!) would need to raise its profile so the ‘consumers’ were aware of it as a potential choice.

Criticisms of the study

With this study it should be noted the subjects were all older adults with acquired disabilities although they were from a variety of cultures and types of disability (mental and physical) which is good. The sample size was small at 10 people, however with phenomenology a smaller sample is needed “quality over quantity” since each person’s narrative is studied in such depth.  If people had disabilities from birth eg CP they may view themselves as more aligned with the social model of disability and not feel the need to justify having assistance provided to them. Another criticism is that in the introduction the authors discuss how the disability models would affect OTs’ practice but this is not addressed again in the rest of the study- would be an area for future research investigation.

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References

Kulnik ST and Nikoletou D (2017) A qualitative study of views on disability and expectations from community rehabilitation service users. Health & Social Care in the Community 25(1): 43–53. Online at http://onlinelibrary.wiley.com/doi/10.1111/hsc.12180/full