According to this article on Medical News Today, a study conducted in the UK revealed that new physicians feel inadequately prepared to care for acutely ill patients. Over the next few weeks, we will be discussing some key acute and critical conditions that future (and current!) physicians should be especially aware of.
One of the most common disorders and most potentially deadly that we see in the Medical ICU is sepsis. Sepsis can occur quickly and, if not recognized and treated swiftly, can kill a patient in a matter of hours. Remember this: A systemic inflammatory response + infection = sepsis. A systemic inflammatory response (SIRS) can occur when there is an insult to the body that causes a cellular reaction that initiates “a number of mediator-induced inflammatory and immune responses” (Gabbard, 2012).
Two or more of the following symptoms indicates a systemic inflammatory response:
- temp >38° or < 36°
- heart rate > 90 bpm
- respiratory rate > 20 bpm or PaCO2 < 32mm Hg
- white blood cell count > 12,000 cells/mm³, < 4000 cells/mm³, or > 10% immature band
In essence, sepsis is basically SIRS caused by an infection or infections – usually gram negative and usually originating in the urinary or respiratory systems. Familiarizing yourself with the pathophysiology of sepsis is of fundamental importance. It is believed to start with activation of the clotting cascade and RBC abnormality that leads to endothelial injury, mitochondrial dysfunction, vasodilation, and fluid redistribution (Gabbard, 2012). When a patient starts to become agitated and restless, as well as tachypnic, tachycardic and hypotensive, these are classic warning signs of sepsis. If left untreated, this process will progress to severe sepsis and ultimately septic shock, which brings with it a rather grim prognosis.
Proactively speaking, the best way to prevent sepsis from even occurring is by treating the underlying infection which causes the response. However, oftentimes sepsis will worsen regardless. The latest critical care guidelines recommend treatment of septic shock with a “Six hour resuscitation bundle” of broad-spectrum antibiotics, aggressive fluid replacement with normal saline, dobutamine and/or blood transfusions to achieve adequate ScvO2 (which measures the oxygen saturation in venous blood returning to the heart and reflect the balance between oxygen delivery and oxygen consumption), and vasopressors to maintain a mean arterial pressure (MAP) of >65 mm Hg (Gabbard, 2012).
Gabbard, E. (2012). Multisystem. CCRN certification exam review. MedEd. www.MedEdSeminars.net
Rattue, P. (2011). Newly qualified doctors feel unprepared to look after acutely ill patients, Medical News Today Retrieved from http://www.medicalnewstoday.com/articles/239309.php