Sepsis: Causes, Symptoms, Treatment and Emergency Care
Sepsis is a special form of the body's inflammatory reaction to the infectious process.Its development means the inability of local immunity to fight the causative agent of the disease and the need to connect all the defenses to destroy the "enemy".Unfortunately, in this case the body begins to destroy itself, and this is the danger of sepsis.Table of contents: Causes of sepsis Symptomatic of sepsis Diagnosis of sepsis Treatment of sepsis
Causes of sepsis
Previously( until about 1991), the main cause of sepsis was considered to be microbes.Especially aggressive microorganisms were thought to penetrate the blood and infect the entire human body.Even the term was used - "contamination of blood".
Modern ideas about sepsis have changed dramatically.No, microbes also play a leading role in the development of this formidable disease, but it is incorrect to consider them as the cause of sepsis.
Before the infection develops into sepsis, the following should happen:
- Disease-causing microorganisms "break through" the protective barriers in the form of skin and mucous membranes and penetrate into tissues.
- The body responds to this by a local inflammatory reaction, seeking to "surround" the infectious agent with impregnable bastions in the form of leukocytes and connective tissue.In the process, the so-called inflammatory mediators are developed - specific substances that indicate the immune cells, where to move, what to do, and also facilitate their penetration to the focus of inflammation.
- This is usually enough to stop the "offensive" of microbes on the body and make the inflammation local.
- With too much aggressiveness of "invading" microbes, local defensive forces are not enough and the second line of defense enters the battle.
- Mediators of inflammation penetrate into the blood, raise all the strength of the body and start sepsis.
Not in every case, an infection, even highly aggressive, can result in sepsis.Moreover, initially a healthy person more often copes( not without the help of drugs) with the disease without experiencing the terrible consequences of its spread.Contribute to the development of sepsis associated chronic diseases, trauma, bleeding, pulling a part of the protective forces.The immune system is forced to constantly struggle with the focus of chronic inflammation( bronchitis, colitis, caries, etc.) and sometimes remaining "in the line" of forces is not enough to cope with the new plague.
Symptomatic of sepsis
Symptoms of pathology can not be called diverse. Actually, they differ little from the signs of any inflammation:
- temperature reaction in the form of fever;
- increased respiration and pulse;
- progressive leukocytosis( increase in the number of leukocytes in the blood).
However, from a banal local inflammation, sepsis is characterized by two things:
- a rapidly developing septic shock;
- is also a rapidly occurring multi-organ failure.
Septic shock - lowering blood pressure below 90 mmHg.In people with signs of an inflammatory reaction.In this case, attempts to replenish the volume of circulating blood are ineffective.
Multiple organ failure is the "failure" of internal organs due to their attack by inflammatory mediators.
No inflammation of any isolated organ can cause these two complications without sepsis.
Diagnosis of sepsis
Treatment of sepsis
It is common knowledge that sepsis is extremely difficult to treat.The mortality rate is extremely high and in some situations reaches 50%.However, timely rendered assistance reduces this indicator at times.
Patients with sepsis are treated in intensive care or intensive care units.This is due to the need for constant monitoring of vital signs. During the first 6 hours of the efforts of doctors are aimed at bringing these figures to a certain value and stabilizing them:
- central venous pressure - up to 8-12 mm.Hg;
- blood pressure - up to 65 mmHg.and higher;
- number of excreted urine - 0.5 ml /( kg * h) or more;
- saturation of mixed venous blood with oxygen - 70% or more.
This is usually achieved by the use of various infusion solutions that are poured through the "dropper", often directly into several peripheral veins or into one central.Sometimes you have to transfuse blood products and add to the solutions drugs that increase blood pressure.
Only these measures already reduce the death rate of patients by 17%( from 50 to 33).
Antibiotic therapy should begin immediately after the establishment of a preliminary diagnosis and no later than one hour after receipt.Apply a wide range of drugs to obtain data on the sensitivity of microorganisms to antimicrobial agents.
Analyzes of wound detachable and other biological fluids should be taken immediately upon admission, even before the onset of antibiotic therapy.
Any patient with signs of sepsis should be carefully examined.Doctors know that there is no sepsis without a focus of inflammation, and therefore they need to find out the source of infection and eliminate it. For this:
- In the presence of an abscess, it is opened, cleaned of pus and drained( special drainage is introduced, allowing a stable outflow of pus from the wound).
- Remove dead tissue in the area of inflammation.If left in place, the body will continue to be poisoned by the products of their decay.
- In the presence of foreign bodies, they should be removed, since without being sterile they also support the infectious process and the inflammation reaction.Moreover, if possible, even those foreign bodies that have been implanted earlier for medical reasons, for example, pacemakers or implanted teeth, are removed.In this case, the doctor must take into account the possible risk for the life of the patient from the removal of a device( removal of the artificial heart valve is guaranteed to kill the patient).
Additional actions are added to all these activities if necessary:
- artificial ventilation;
- use of funds that support cardiac activity;
- hormone therapy for the suppression of excessive inflammation;
- control of blood sugar level by prescribing hypoglycemic agents;
- treatment of acute renal failure;
- prophylaxis of deep vein thrombosis;
- prevention of ulcerative gastrointestinal lesions on the background of severe stress.
It is proved that for the onset of sepsis, even a severe purulent disease is not enough.In its development, a number of factors are involved, including age, concomitant diseases, the state of immunity and even the adequacy of the diet.Nevertheless, the greatest danger of this disease forces scientists around the world to continue research in order to find the best way to fight the disease in order to reduce the death rate from it to zero.
About the reasons for the development of sepsis and the methods of its treatment the specialist tells:
Bozbey Gennadiy, medical reviewer, ambulance doctor