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Sepsis is responsible for 52,000 deaths in the UK each year. A distressing 250,000 people contract the condition, which can have life changing implications; such as amputations, internal organ failure and brain damage.

Why has sepsis been in the news?

Caught early, the outcome from sepsis is good. It is the delay in treatment that can lead to spiralling of the condition resulting in multi-organ failure and potential death. The Sepsis Trust claims that improved national awareness could save as many as 14,000 lives a year.

Sadly, the early symptoms are often easy to miss and often there is a delay in Emergency Services, GPs and hospital staff recognising the condition. This delay has major implications and often the window of opportunity when antibiotics can treat the sepsis, is missed.

What is sepsis?

Sepsis arises due to the body’s abnormal response to an infection. The immune system usually works to fight any germs (such as bacteria, viruses and fungi) and infection in the body. However, for reasons that are not fully understood, sepsis results in the immune system going into overdrive and attacking health organs and other tissues.

What damage does it cause?

This inflammation causes injury to the body’s tissues and organs. The initial, localised infection spreads into the blood stream and is circulated around the body spreading and increasing the damage. This life-threatening breakdown in circulation can lead to organs all over the body being affected, including the brain, lungs, heart, skin and kidneys.

What has septicaemia got to do with it?

Sepsis is sometimes referred to as septicaemia or blood poisoning. However, septicaemia is an old, now defunct term which implied there was something we could measure in the blood which indicated sepsis – this is not the case.  Sepsis is the preferred and more accurate term for the condition.

What causes sepsis?

Sepsis can be triggered by an infection in any part of the body. The most common causes of sepsis are the following;

1. Pneumonia (or a chest infection),
2. Urinary infections,
3. Intra-abdominal infections (such as a burst ulcer or hole in the bowel),
4. Skin infections (an infected cut or bite),
5. A wound from trauma or surgery,
6. Soft tissue infections (a leg ulcer for example).

Most cases are caused by common bacteria which wouldn’t normally induce illness. Trauma is responsible for 2-3% of reported cases.

Is it linked with meningitis?

Meningitis causes less than 1% of adult cases of sepsis. However, it is the cause in around 10% of cases in children.

Whilst most cases of meningitis are viral and therefore not life-threatening (or sepsis-inducing), a minority are bacterial infections and can lead to sepsis. Both conditions are serious and so it is important to be able to recognise common early signs and symptoms.

What is sepsis in more detail?

Sepsis is a massive reaction that damages blood flow all over the body. The immune system releases chemicals causing tiny blood vessels (capillaries) to leak fluid into the surrounding tissues. This causes inflammation which can ultimately lead to reduced blood flow to vital organs and organ damage.

The chemicals  damage the capillary walls, which leak even more, causing dangerously low blood pressure. Blood clots try to repair the damage, but many break loose, causing blockages and further impairing blood flow to tissues.

If the cellular metabolism is damaged in this way and blood pressure drops to dangerously low levels, the amount of blood and oxygen reaching the body’s organs is reduced and prevents them functioning properly. This is known as septic shock.

What needs to be improved nationally?

The Royal College of Nursing held a conference in May 2019 in which they stressed the need for an urgent dissemination of a national Paediatric Early Warning Score to improve identification of the signs of sepsis in children. Currently, between 1000 and 4000 children die each year from the condition. An adult symptoms checklist is already used by the NHS, but trusts use individual systems for children which results in an inconsistent and unreliable approach

A symptoms checklist for adults already exists but NHS trusts often use their own systems for children. The children’s checklist would help medics spot when a youngster is deteriorating through:

1. Checking temperature,
2. Heart rate,
3. Respiration rate,
4. Other signs, such as urination, skin colour and rash.

The Sepsis Trust claim that patients presenting early being around half as likely to die than those presenting late. This emphasises the importance of awareness.

The condition deteriorates in children far quicker, and therefore it is particularly important for those in childcaring positions to be fully informed of the signs and symptoms.

What would I feel like if I had sepsis?

1. Flu-like symptoms are common,
2. Chest infection or gastroenteritis type symptoms,
3. Feverish and shivering – although sepsis can cause an abnormally high or low temperature.
4. Rapid heartbeat,
5. Quick breathing
6. Feeling extremely unwell.

In more extreme cases, you may experience:

• Dizziness,
• Feel faint,
• Disorientation and confusion,
• Nausea and vomiting,
• Diarrhoea,
• Cold, clammy, pale or mottled skin.

In children:

1. Fast breathing,
2. Lethargic behaviour and fatigue,
3. Mottled, bluish or pale skin,
4. Fits or convulsions,
5. Failure to pass urine,
6. A rash that doesn’t fade when pressed – NEVER wait for a rash, it is often a very late sign and may not show at all.

Any baby or child under 5 years old who is not feeding, vomiting repeatedly or hasn’t had a wee or wet nappy for 12 hours, might have sepsis.

What do I need to remember?

If you think you have these symptoms, or feel that something isn’t right, seek urgent medical advice (e.g. call NHS 111 or go into hospital). It is vital that you trust your instincts and get help to fight the infection as fast as possible.

Written by Emma Hammett for First Aid for Life

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