Are they exaggerating on sepsis or am i wrong?

MrNurse(x2), ADN · Oct 5, 2016

The criteria for that diagnosis has changed. There is now a quantifiable lab test (lactate) being used for diagnosis.

macawake, MSN · Oct 5, 2016

It seems like some, maybe most, nurses are using the word sepsis too much. It seems to me like every time there is an infection, someone is referring to it as sepsis. Every time we have an abscess, cellulitis or any other kind of a wound, you hear in the report that that patient came in with sepsis. When i look back in the said charts, i don't see doctors mentioning sepsis anywhere. Are they exaggerating or am i wrong on this?

I have no idea if people around you use the term sepsis too much, but it's certainly true that not every infection or abscess equals sepsis.

Sepsis is the body's (systemic) inflammatory response to a severe infection. It's a very serious condition and if it progresses to septic shock; (persisting hypotension requiring vasopressors to maintain an adequate MAP and an elevated serum lactate despite adequate volume resuscitation) it has a high mortality rate. Sepsis is caused by the immune system's release of chemical messengers in an attempt to fight off the infection.

(I've heard people use the term septicemia (which is the presence of pathogens in the bloodstream) when they mean sepsis but the two aren't as I understand it interchangeable. The physicians I work with seldom use the term septicemia for "blood poisoning" but instead identify the culprit pathogen by using the terms bacteremia or fungemia).

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) | Feb 23, 2

mindofmidwifery, ADN · Oct 5, 2016

Sepsis is a hot word in our ED. If the word "sepsis" comes out of anyone's mouth we freak out. That's because we work hard to catch and treat it quickly. We have a "sepsis alert" process when someone comes in with possible sepsis. So no, nobody in my department uses it unless it's truly sepsis or a true case of POSSIBLE sepsis.

loriangel14, RN · Oct 5, 2016

Where I work there is a criteria including bloodwork that defines sepsis. If you got the criteria then you are a confirmed case. Otherwise they just say possible sepsis. I think some systems are trying to identify it earlier so it can be treated swiftly.

AceOfHearts<3 · Oct 5, 2016

In my system it's based off lab work and vital signs. I have had patients that I truly have thought were septic that I watched like a hawk since they can rapidly decline. I had the alert pop up once for a patient that met most of the criteria, but that I knew was not septic (he was very very sick, but it was all cardiac related- had an IABP put in and other major intervention once I got him off my unit and up to the ICU).

chare · Oct 5, 2016

juan de la cruz, MSN, RN, NP Guide wrote an informative blog Adult Critical Care Update: New Definitions of Sepsis and Septic Shock discussing this. The article he referenced is available here: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Additional information regarding the new definitions is available here: Sepsis Definitions

The Society of Critical Care Medicine's Surviving Sepsis Campaign current guidelines are available here: Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012.

stepbystep12, BSN, DNP · Oct 5, 2016

Thanks all. I am in agreement with you people.

Susie2310 · Oct 6, 2016

The new guidelines/definitions above do not appear to mention the hyper dynamic stage (early sepsis) when the patient experiences feeling hot and flushed, may be diaphoretic, with malaise, lethargy, changes in level of consciousness, increased pulse and increased blood pressure, and an elevated or subnormal temperature. It is extremely important to catch sepsis as early on as possible so that treatment can be initiated as soon as possible, as mortality rises for every hour that the patient goes untreated.

I have family members who have nearly died from both severe sepsis and sepsis. In both cases they experienced the above symptoms, along with other symptoms specific to the source of infection, such as severe diarrhea/vomiting. Recognizing the earlier signs of sepsis is hugely important, both from the point of view of practitioners and patients. In the case of my family member who had severe sepsis, their blood pressure had decreased to 80 systolic by the time they were diagnosed, heart rate was around 120, and they were in acute renal failure. After a long delay they received treatment not in an ICU but on a med-surg unit, of rapid IV fluid boluses and antibiotics. Fortunately they began to produce urine after several liters of IV fluid. They spent the entire year recovering after discharge and sustained some permanent kidney damage. In the case of my family member with sepsis, again they received a delay in diagnosis and treatment (not our fault), but received IV fluid resuscitation and antibiotics before they reached the stage of their blood pressure dropping, and while they avoided acute renal failure the experience was utterly exhausting for them and they barely survived.

It is very important to recognize the earlier stages of sepsis. By the time the patient is hypotensive with tachycardia and is experiencing organ failure/s they are in the stage apparently now formerly known as severe sepsis, when their chances of survival are even more decreased. The elderly in particular, with already diminished physical reserves at baseline, are particularly susceptible to sepsis and the progression to septic shock, and their symptoms may not be as obvious so they are already at increased risk if a prolonged period before diagnosis and treatment takes place.

kay91 · Oct 6, 2016

Sepsis is definitely a word used a lot more frequently where I work. But it's mainly related to the MEWs vitals that we do. If someone's vitals are off to a certain extent, we fill out a sepsis screening tool and take vitals every 2 hours and the nurse has to be the one taking the vitals. If the vitals are out of limits enough; we have to call a rapid response or even a code sepsis which then gets the labs ordered and if they're not already on them, the proper antibiotics. If the lactic acid is off or the procalcitonin, we definitely start using that word more of course.

I did have a patient once who i thought was for sure septic. Their vitals were off all day: temp high, Bp low, tachycaric. With multiple boluses, Tylenol, and vitals q2, patient was fine overnight then. turned out later that their port was infected.

stepbystep12, BSN, DNP · Oct 6, 2016

Thanks all. Very informative. Keep them coming!

vintage_RN, BSN, RN · Oct 6, 2016

Interesting. I have seen patients admitted on my floor with a diagnosis of "Sepsis NYD" but all I can see are maybe positive blood cultures and they're on antibiotics - I don't think that really qualifies as sepsis. Interesting to note the change in practice to include bloodwork, I'm not sure if we are always checking serum lactate levels but I'm going to look for it next time I see a patient like this.