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Is there a reason why Septic is a redirect to Sepsis? I don't quite understand it from the article text. -- Timc 03:22, 6 Jun 2004 (UTC)
I can't find anything related to what happens to babies born with sepsis, I was born with sepsis, and I turned out to be a very withdrawn child who was very afraid of people. -- 86.18.156.77 16:28, 25 December 2006 (UTC)
I think the article should mention the high incidence of sepsis following gunshot wounds to the abdomen. My understanding is that this is caused by wholesale leaking of GI material from punctured (or eviscerated) bowel and colon into the abdominal cavity, and that left unchecked death from massive sepsis can occur with 24-36 hours. This article discusses GSWs in Lagos (where prompt surgery and antibiotics clearly aren't always available). Also, I understand a large number of battlefield deaths in WW1 (particularly at the beginning, before they figured out surgical methods for treating abdominal injuries) were due to gunshot-related sepsis. -- Finlay McWalter | Talk 00:53, 19 Aug 2004 (UTC)
Could someone who knows about septicemia please make a separate article instead of a redirect?
My 2 month pregnant, 26 year old friend died last week. It started 3 weeks ago with up and down fever and head pain.After one week in the hospital she could not speak any more and a week later she died. The death certificate announce: SEPTICEMIA, UTI, MAJOR DEPRESSIVE MOOD WITH PHYCITOSIS. Can a young person like her die that fast from it? Tom Philippines April.06
It seems to me that the article is lacking a clear definition of what sepsis "is" (as opposed to what it does, or how it is diagnosed.) As far as I know, sepsis is when the perfectly clean, antiseptic state of the inside of the body is compromised (eg. hole in the stomach leads to food actually entering the bloodstream and organ cavities). Is this correct? Either way, the page needs a better definition than the non-definition of "sepsis is a serious medical condition caused by a severe infection." I mean, I reread the article and there is literally no section describing what it is the article is talking about! I would fix this myself, but I only have the shaky definition I wrote above. 65.94.230.83 17:48, 15 April 2006 (UTC)
Under the "Symptoms" heading, the definition appears more to be "signs" than actual symptoms. Symptoms should be what the patient experiences or can report about his/her condition, signs would be what the doctor can conclude from tests or observation. I would like to see more discussion of what symptoms patients normally experience, such as the ones discussed on this page, like high fever, pain, difficulty breathing, etc., under the "Symptoms" heading. And then perhaps the heading should read "Signs and Symptoms," instead. My mother just died of sepsis due ultimately to multiple myeloma, and we thought she had bronchitis, the symptoms were similar. Kelelain 16:23, 25 January 2007 (UTC)Kelelain, 25 January 2007
From what I understand, Sepsis can be "defined" as an inflammatory response to an infection. The diagnosis MUST include a documented infection, and as others have already stated, a number of other criteria such as increased heart and respiratory rate. There is a paper that outlines these criteria quite well: Merx and Weber (2007). Sepsis and the Heart. Circulation 116:593-802. Grim Faerie ( talk) 14:36, 18 August 2008 (UTC)
This article needs a timeline or something like that, to tell how long a person with sepsis has to live. Sepsis is also very common from gunshot wounds, which is not present in the article.
I had a baby 14 months ago and due to neglegence of the hospital I ended up with septicemia. Had 4 ops in two weeks including debridements and a historectomy. Nowhere in this talk does it say anything about what sepsis does afterwards. During my septic period i had considerable pain in my right hip and leg. As soon as the white blood cell count came down the pain would go away, when the count picked up it would be back. After the historectomy the count came down to almost normal and I was sent home. I still today have lots and lots of problems with my hip and my leg, can't sit crossed legged, can't sit stand or lie down for long periods without moving. No site that I have visited actually gives you information on what happens after this illness. Maybe you can look at doing something like this. —The preceding unsigned comment was added by 168.209.98.68 ( talk • contribs) 2006-07-25t11:02:37z.
This topic is in need of attention from an expert on the subject. The section or sections that need attention may be noted in a message below. |
-- Jeandré, 2006-08-08 t21:50z
Minor edit: When the infection crosses into sepsis, the symptoms of tachycardia, tachypnea, fever and/or decreased urination.
to
When the infection crosses into sepsis, the resulting symptoms are tachycardia, tachypnea, fever and/or decreased urination. DanMcScience 20:01, 17 April 2007 (UTC)
Post: Re: clear definition; septic; septicemia:
Sepsis is a medical term that refers to combination of conditions. If a person has those conditions, then we may refer to that person as "septic".
Understanding sepsis, and how it relates to infection is important because it can sometimes develop into severe, life-threatening illness, such as septic shock or multi-organ dysfunction syndrome, which are very often deadly.
The presence of sepsis requires that 2 things must be present at the same time:
The infection can originate anywhere in the body, but most often it starts in the lungs or in the urinary tract. Occasionally, it can be the result of a wound which then gets dirty, such as a gunshot wound, a surgical wound, or even a cut from broken glass, where bacteria or rarely fungus start to grow and multiply.
Normally, the immune system will contain the infection and destroy the offending bacteria right where they are. The area where the bacteria are multiplying may get hot, tender and red - this is evidence of INFLAMMATION. INFLAMMATION is tissue damage from a combination of toxins produced by the bacteria, and toxins produced by the immune system (that damage both bacteria, as well as surrounding tissue cells). If the infection is large enough, or lasts long enough, these toxins can enter the bloodstream by being absorbed into nearby veins. When this happens, it is called toxemia or septicemia (the suffix "-emia" means something "in the bloodstream").
These toxins travel through the bloodstream to distant organs and are responsible for making you feel sick, fatigued, achy, and nauseous. When they reach the brain in enough amounts, they signal the brain to raise the temperature of your body, and you will shiver uncontrollably. This is why people feel "chills" and experience what nurses and doctors call "rigors". Eventually your temperature will rise, and you will have a fever. This combination of fever, rapid heart rate, fast breathing is the body's response to a serious infection, and this is what we call SEPSIS. When this occurs, it usually means the infection is worsening.
Other changes can occur as well, some of which will only show as abnormalities on lab tests, such as increased white blood cell count, increased acid in the blood (acidemia), increased platelets, and an increase in certain proteins called "acute phase reactants". Doctors can test the blood and guess how severe an infection is by how severe someone's reaction to it is. Normally an infection will have to be quite severe or widespread before sepsis occurs.
However, everyone is different, and may react differently to the same amount of bacteria or toxin. Similarly, some bacteria produce very large amounts of or extremely toxic chemicals, that will mean sepsis occurs much earlier than in another case. As it progresses, you may experience more and more of the symptoms of sepsis, and they will become more and more severe. Hence, there are varying degrees of sepsis, from mild to severe. A person with a viral throat infection may have a rapid heart rate and a low-grade fever (less than 39 celsius) and feel fatigued. Their blood may have an increased number of white cells. Such a person could be said to be "mildly septic". This would be very different from someone with severe sepsis, who has a fever of 41, and a heart rate of 170 beats per minute, who is confused and delerious. That is to say, there are varying degrees of sepsis, from mild to severe.
To confuse matters, some people will NOT develop all of the signs or symptoms of sepsis before they progress to more severe forms. Many people, especially the very young and the elderly, for example, can even develop septic shock without ever having a fever. Some people take medications which slow the heart rate or suppress inflammation, which can mask some of the other signs and symptoms. Some people, such as organ-transplant recipients, have comprimised immune systems. It can be very difficult to diagnose sepsis in these cases. Usually however, there will be enough evidence for a doctor or other health care professional to recognize what is happening before things get out of hand.
Occasionally, the immune system will be unable to contain the bacteria before they leak into the bloodstream. This produces a very dangerous condition called bacteremia. The bacteria can lodge in distant organs such as joints, liver, kidneys, spleen, even in the heart valves. This can make it very difficult to tell where the original infection came from. It also makes the infection very difficult to treat.
This is more dangerous however, because it can activate the immune system in many places in the body all at once. However, you dont necessarily need bacteria in the blood to cause this. An infection can become so severe that large amounts of toxins are released into the blood stream. Usually by this time, however the blood will be colonized by the organism which caused the infection. widespread tissue damage, and affects the ability of the blood vessells to keep blood cells and plasma inside them. This will often result in a drop in blood pressure. When this happens, sepsis is said to be "severe sepsis". At this stage, unless the condition is diagnosed and rapidly treated, then death can be imminent. Doctors will often use intravenous fluids to raise the blood pressure of someone with severe sepsis. If this does not work, and the blood pressure stays below normal, the person is said to be in "Septic Shock".
When the blood and plasma begin to leak out of the blood vessells, they can no longer be pumped effectively to organs. Then, the organs no longer work properly and can produce even MORE toxic chemicals as they malfunction and their cells begin to die. This state is a further progression of severe sepsis and is called Multi-Organ Dysfunction, or MODS.
This response to inflammation, and progression to MODS is NOT always caused by infection: anyone with a serious allergy can attest that during a reaction, they feel as if their whole body is reacting similarly, and indeed it is. Doctors noticed over the years that regardless of the cause, there is a clear sequence of events following widespread activation of the immune system that can lead to death if not treated. Sometimes this progression halts itself, but the farther along you get, the less likely it will stop on its own. This is why doctors have carefully defined these terms and use them in a very specific way. It is vital to diagnose and treat infections before they progress to sepsis. Likewise, it is very important and recognize when someone is having a widespread immune reaction to something other than infection, a state called "Systemic Inflammatory Response Syndrome", or "SIRS".
SIRS can be caused by many things, including advanced cancer, trauma, burns, pancreatitis, severe allergic reactions (when it is called "anaphylaxis") and infection. When infection causes SIRS, we call that "sepsis". Sepsis and SIRS can lead to other things such as fluid in the lungs and the blood to spontaneously clot.
The Systemic Inflammatory Response Syndrome has a very precise definition, as does "sepsis" when it is used by doctors. Unfortunately, without understanding what SIRS is, the technical definition of sepsis is difficult to understand. Add to that the fact that most people have some idea of what is meant by sepsis, and it makes attempting a definition quite difficult. The definition of "SIRS" is at least 2 of the following 4:
The techinical definition of "sepsis", as used by doctors, is: SIRS, plus evidence of infection.
(adapted from --- American College of Chest Physicians: Society of Critical Care Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit. Care Med. 20:864-875, 1992)
What exactly is evidence of infection? Certain things are obvious, such as culturing bacteria from a normally bacteria-free site (such as blood, urinary tract, knee joint), or having signs or symptoms of common infections like pneumonia, bronchitis, and cystitis (bladder infection). However as many as half of people with severe bacterial infections will not grow bacteria from blood cultures, and most doctors can diagnose many common infections without even obtaining a blood sample. Consequently, this part of the definition is not agreed upon by every doctor. The best agreed upon definitions leave some room for error, by saying "strong clinical suspicion of infection" rather than "evidence of infection". Clearly, it is better to treat too much rather than too little when the stakes are so high.
To summarize, sepsis is widespread inflammation caused by your immune system responding to a serious (but not always life-threatening) infection. Sepsis is a special case of the more general condition, "SIRS". Sepsis can be very difficult to diagnose in the young, the elderly and those taking immune-suppressing medications. Recognizing it early is important because it can be deadly if left untreated. Even without causing death it can permanently damage organs such as the liver, kidneys, and heart. It may have other long-term effects, depending on the site of the infection, but these are more likely to be caused by the infection itself. Most people with sepsis will get better once the infection clears up; but it is important to be assessed by your doctor or other health care professional to find out for sure. 142.162.71.240 20:48, 20 June 2007 (UTC) CWR B.Sc, M.D. (Canada)
Does anyone actually use the term septicemia clinically anymore? Medline Plus basically states that it is synonymous with bacteremia with sepsis, which seems more to the point and less obfuscatory, and which I think should replace all instances of septicemia in the article. And septicemia doesn't fit the pattern for similar words like bacteremia, fungemia, or viremia, which basically denote something floating around in the blood stream (something + Gk 'emia' blood). If you say septicemia, what exactly is the thing that is floating around? Aswang ( talk) 20:14, 26 February 2008 (UTC)
Hi there, as an ITU nurse i can respond to this by saying that "Septicaemia" is very rarely used within the clinical setting.
Sepsis and Septic are used more widely to describe the huge spectrum of possible causes and as "Septicaemia" is actually directly related to blood poisoning it can lead to relatives percieving their loved ones to have a medical condition that they don't actually have. A person does not have to have bacteria in their blood stream in order to become septic. For example a great many septic patients become unwell from something as simple as a chest infection which does not respond to treatment at home, the infection then progresses quite aggressively and soon becomes a pneumonia. Not at anytime when blood cultures are taken is any bacteria detected in the blood stream. It must be highlighted that in most cases it is the bodies own reaction that causes a great many of the problems we face when fighting sepsis today. I fear that the piece is severely lacking a comprehensive "Physiology/pathophysiology" section and (even though i am quite new to this) i covered sepsis in some detail during my ITU course and would be happy to provide something if others to believe it would be helpful.
Septicaemia today is used (to the best of my knowledge) for the description of Bacterial Menningicoccal Spepticaemia as this is an infiltration of the blood by a highly fatal and aggressive bacteria. Septicaemia is characterised by discolouration of the skin due to the rapidly flowing toxins and with Meningicoccal infection can often lead to the loss of limbs due to the rapid cell death.
I would also like to add that it is documented that a respiratory rate of over 20 and PaCo2 of less that 4.3kpa is one symptom when in my practice it is a RR exceeding 30 that can severely compromise Co2 levels and that high Co2 levels are also indicative of sepsis. I do have many hundreds of references that may be of use but its 11 o clock at night and i have just finished a very busy late shift so you will forgive me for not having a moment to dig out the more useful ones right now, however if anyone feels i could be of use to this article then i would be happy to help (i have a huge facination with the topic).
It may also be useful to include something on the now hugely publisised Surviving Sepsis Campaign and Sepsis Care Bundles??? -- Basha440 ( talk) 22:16, 3 April 2008 (UTC)
I can only speak from the medical record coding side of things but we've had it drilled into us that bacteremia is simply an asymptomatic positive blood culture and sepsis requires evidence of SIRS. If the patient is symptomatic but those symptoms aren't serious enough to constitute SIRS then that is where septicemia lies and where the septicemia code alone should be used (In ICD-9 the dx of sepsis uses the combination of the codes for septicemia (038.x) plus the code for SIRS due to an infectious process (995.91)). Of course, you have to go by what the doctor actually documents rather than diagnosing things on your own - and doctors often have a terrible tendency to use the terms bacteremia and sepsis interchangeably).-- 209.7.195.158 ( talk) 16:20, 26 May 2009 (UTC)
Doesn't seem to be anything on here on what causes these contaminants to get in the blood. 67.189.104.78 ( talk) 07:24, 6 August 2008 (UTC)
Section implies that everyone who has sepsis dies in 6 month. Clearly not true. Milik ( talk)
Note the following sentence: "Septicemia (Also, septicaemia [sep⋅ti⋅cae⋅mi⋅a][3], or erroneously Septasemia and 'Septisema') is a related but depreciated (formerly sanctioned medical) term referring to the presence of pathogenic organisms in the bloodstream, leading to sepsis." I have practically no medical experience, but doesn't "depreciate" mean "reduce in monetary value; amortize" and "deprecate" mean "to phase out or recommend against use of"? To me, "deprecate" makes more sense in this sentence. Opinions? Thanks -- Jon vs ( talk) 07:05, 26 March 2009 (UTC)
The second half of the Epidemiology section seems to contain opinion statements, but I lack the medical expertise or documentation to make the appropriate changes. Opinion statements include "the (sometimes unnecessary) use of sedation", "which runs rampants (sic) in hospitals", and "often makes the beds of intensive care patients become death beds." -- 72.211.209.110 ( talk) 18:50, 22 April 2009 (UTC)
Blood poisoning redirects here; however, lymphangitis is also called blood poisoning. JN 466 18:53, 24 May 2009 (UTC)
What kind of picture is wanted? Doc James ( talk · contribs · email) 08:47, 7 February 2010 (UTC)
i had a papsmear done recently. and i was told that i had a very large number of white blood cell. they said it looked like some one took a cup full of wbc and poured it onto a slide. they were unable to tell me exactly what the cause was. they did some blood test and they all came back normal. i am scared that it may be something serious. can you tell me what i can do to find out exactly what is wrong? —Preceding unsigned comment added by 98.173.180.39 ( talk) 19:11, 15 April 2010 (UTC)
Someone added a request for citiation after the second set of units. I have removed the request. In my opinion, converting between cells/mm3 and cells/L is a trivial exercise and does not warrant a citation request. The relevant section of text is below:
-- Gak ( talk) 08:54, 11 June 2010 (UTC)
What's the deal with this? I am going to remove it. If anyone disagrees please reinstate it and explain.-- Adam in MO Talk 21:09, 18 November 2010 (UTC)
Is procalcitonin (PCT) testing not widely enough used in USA or elsewhere for sepsis rule-in or rule-out to be mentioned in this article ? - Rod57 ( talk) 15:43, 5 May 2011 (UTC)
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help)Doc James ( talk · contribs · email) (if I write on your page reply on mine) 10:31, 4 November 2012 (UTC)
More References:
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link)Mike Turken ( talk · contribs · email) (If I write on your page, please reply on mine.) 02:02, 21 December 2012 (UTC)
What should we use in the lead? A picture of the meningitis rash. A picture of bacteria. A picture of the classification system [4] Doc James ( talk · contribs · email) (if I write on your page reply on mine) 03:48, 5 November 2012 (UTC)
Again, I highly suggest you change the picture of the baby's arms. It very disturbing and I'm sure there's a more appropriate picture out there. — Preceding unsigned comment added by 76.175.105.92 ( talk) 07:49, 19 January 2013 (UTC)
Dellinger, RP (2013 Feb). "Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012". Critical care medicine. 41 (2): 580–637.
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Doc James ( talk · contribs · email) (if I write on your page reply on mine) 03:30, 23 February 2013 (UTC)
Awesome! Thanks for posting this. And thanks for changing the photo, too.
Mike Turken (
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email) (If I write on your page, please reply on mine.) 21:00, 1 March 2013 (UTC)
doi:10.1164/rccm.201211-1983OC - not (yet) for inclusion, but postmortem results show that those dying from sepsis have cardiomyocyte injury and focal renal tubular abnormalities. JFW | T@lk 13:54, 1 March 2013 (UTC)
Observational studies have alluded to a benefit from statins, but most of the research is too weak to draw strong conclusions (says meta-analysis). doi:10.1186/cc13828 JFW | T@lk 19:58, 28 April 2014 (UTC)
Trying to incorporate new Surviving Sepsis Campaign diagnostic criteria into a table. Any thoughts about size/usability? Will edit text so that it's not so directly taken from the guidelines. But I also wondered if it might be more valuable to organize by kind of finding (physical exam vs. lab, or break it down by vitals). Thoughts?
General | Inflammatory markers | Hemodynamics and perfusion | Organ dysfunction |
---|---|---|---|
Fever >38.3C | Leukocytosis (WBC count >12,000/uL) | Arterial Hypotension ( SBP <90mm HG, MAP <70mmHg, or an SBP decrease >40mm Hg in adults or less than 2 SD below normal for age) | Arterial hypoxemia (PaO2/FIO2<300) |
Hypothermia < 36C | Low white blood cell (count <4,000/uL) | High lactate level (> 1 mmol/L) | Acute oliguria (urine output < 0.5 mL/kg/hr for at least 2 hrs despite adequate fluid resuscitation) |
Heart Rate >90/min or more than 2SD above normal value for age >38.3C | Normal WBC count with greater than 10% immature forms | Decreased capillary refill or mottling | Creatinine increase > 0.5mg/dL or 44.2 μmol/L |
Tachypnea | Plasma C-reactive protein more than 2SD above normal | Coagulation abnormalities (INR > 1.5 or aPTT > 60 s) | |
Altered mental status | Plasma procalcitonin more than 2SD above normal | Absent bowel sounds | |
Significant edema or positive fluid balance (>20mL/kg over 24hr) | Low platelets (platelet count < 100,000/μL) | ||
High blood sugar (plasma glucose>140mg/dL in the absence of diabetes) | Hyperbilirubinemia (plasma total bilirubin > 4mg/dL or 70 μmol/L) |
Mike Turken ( talk · contribs · email) (If I write on your page, please reply on mine.) 18:29, 30 April 2013 (UTC)
References
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Why do we need the NEJM blog [6] as a ref? When the full article is freely accessible here [7]? Blogs are not typically deemed reliable sources. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 20:26, 7 September 2013 (UTC)
I set it with the layurl parameter. - - MrBill3 ( talk) 08:08, 26 November 2014 (UTC)
I have uniformly formatted the references. For journals I have used last name, first initial with displayauthors set to 4. I used the full journal name and wl'd when possible. I have added urls to content available online. While the doi is more stable, a doi provides no clue if a subscription is required for a particular article. Where the url is not from the publisher I have added the via parameter to help resolve any copyright issues. To the extent possible I have completed the references, full author listing, pmid, doi etc.
If the authorship is attributed to a group(s), I used the group(s) as the first author. This isn't standard in scholarly citations but I think it is appropriate on WP. I made one exception where there were a multitude of groups all named in the title of the article.
I have also set up auto archiving for this talk page, 90 days, archive by number, indexed using ClueBot III.
I added a few update needed tags, one for a Cochrane review that has a more recent version and one for the Surviving Sepsis 2008 guidelines for which we should be using the 2012 guidelines (already a named ref in the article). Best. - - MrBill3 ( talk) 08:04, 26 November 2014 (UTC)
... after severe sepsis is logical but has been extremely poorly studied. doi:10.1002/jhm.2281. Probably can't be included as the review concedes that the research still needs to be done. JFW | T@lk 17:48, 19 November 2014 (UTC)
Angus, DC; van der Poll, T (August 29, 2013).
"Severe sepsis and septic shock".
The New England Journal of Medicine. 369 (9): 840–51.
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Doc James (
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Sepsis can be thought of as falling within a continuum from infection to multiple organ dysfunction syndrome. [1] Moved here as not really true. Doc James ( talk · contribs · email) 10:58, 28 November 2014 (UTC)
References
The section "Cause" could probably be improved. I have updated the reference, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases to the 8th ed. with a link to the chapter. The Google Books preview from my location allows the chapter to be read. I think the section does not represent what the source says precisely (this edition seems updated). It's great to see this important article getting some work.
As a side note, I can provide a single copy of the updated Cochrane article to an editor for improving this article via email. - - MrBill3 ( talk) 06:15, 29 November 2014 (UTC)
This "In 2006, following the Surviving Sepsis Campaign a set of medical therapies aimed at reducing the mortality rates from severe sepsis was developed by those workers involved in the campaign. These were named the Sepsis Six and consists of three diagnostic and three therapeutic steps – all to be delivered within one hour of the initial diagnosis of sepsis.
Deliver high-flow oxygen. Take blood cultures. Administer empiric intravenous antibiotics. Measure serum lactate and send full blood count. Start intravenous fluid resuscitation. Commence accurate urine output measurement.
The adoption of the Sepsis Six in centres in many countries has been associated with decreased mortality, decreased length of hospitalisation and days spent in intensive care units. [1]"
Is not supported by a good enough ref. Does not belong in the treatment section as half of it is diagnosis. And is already covered. Doc James ( talk · contribs · email) 15:27, 4 December 2014 (UTC)
References
Sepsis is SIRS plus infection. I think we need to keep the lead simple. Thus removed "SIRS can also be caused by other non-infectious conditions such as pancreatitis, reperfusion injury, or cancer." as this is in the body already. Doc James ( talk · contribs · email) 14:17, 6 December 2014 (UTC)
This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page. |
Archive 1 | Archive 2 |
Is there a reason why Septic is a redirect to Sepsis? I don't quite understand it from the article text. -- Timc 03:22, 6 Jun 2004 (UTC)
I can't find anything related to what happens to babies born with sepsis, I was born with sepsis, and I turned out to be a very withdrawn child who was very afraid of people. -- 86.18.156.77 16:28, 25 December 2006 (UTC)
I think the article should mention the high incidence of sepsis following gunshot wounds to the abdomen. My understanding is that this is caused by wholesale leaking of GI material from punctured (or eviscerated) bowel and colon into the abdominal cavity, and that left unchecked death from massive sepsis can occur with 24-36 hours. This article discusses GSWs in Lagos (where prompt surgery and antibiotics clearly aren't always available). Also, I understand a large number of battlefield deaths in WW1 (particularly at the beginning, before they figured out surgical methods for treating abdominal injuries) were due to gunshot-related sepsis. -- Finlay McWalter | Talk 00:53, 19 Aug 2004 (UTC)
Could someone who knows about septicemia please make a separate article instead of a redirect?
My 2 month pregnant, 26 year old friend died last week. It started 3 weeks ago with up and down fever and head pain.After one week in the hospital she could not speak any more and a week later she died. The death certificate announce: SEPTICEMIA, UTI, MAJOR DEPRESSIVE MOOD WITH PHYCITOSIS. Can a young person like her die that fast from it? Tom Philippines April.06
It seems to me that the article is lacking a clear definition of what sepsis "is" (as opposed to what it does, or how it is diagnosed.) As far as I know, sepsis is when the perfectly clean, antiseptic state of the inside of the body is compromised (eg. hole in the stomach leads to food actually entering the bloodstream and organ cavities). Is this correct? Either way, the page needs a better definition than the non-definition of "sepsis is a serious medical condition caused by a severe infection." I mean, I reread the article and there is literally no section describing what it is the article is talking about! I would fix this myself, but I only have the shaky definition I wrote above. 65.94.230.83 17:48, 15 April 2006 (UTC)
Under the "Symptoms" heading, the definition appears more to be "signs" than actual symptoms. Symptoms should be what the patient experiences or can report about his/her condition, signs would be what the doctor can conclude from tests or observation. I would like to see more discussion of what symptoms patients normally experience, such as the ones discussed on this page, like high fever, pain, difficulty breathing, etc., under the "Symptoms" heading. And then perhaps the heading should read "Signs and Symptoms," instead. My mother just died of sepsis due ultimately to multiple myeloma, and we thought she had bronchitis, the symptoms were similar. Kelelain 16:23, 25 January 2007 (UTC)Kelelain, 25 January 2007
From what I understand, Sepsis can be "defined" as an inflammatory response to an infection. The diagnosis MUST include a documented infection, and as others have already stated, a number of other criteria such as increased heart and respiratory rate. There is a paper that outlines these criteria quite well: Merx and Weber (2007). Sepsis and the Heart. Circulation 116:593-802. Grim Faerie ( talk) 14:36, 18 August 2008 (UTC)
This article needs a timeline or something like that, to tell how long a person with sepsis has to live. Sepsis is also very common from gunshot wounds, which is not present in the article.
I had a baby 14 months ago and due to neglegence of the hospital I ended up with septicemia. Had 4 ops in two weeks including debridements and a historectomy. Nowhere in this talk does it say anything about what sepsis does afterwards. During my septic period i had considerable pain in my right hip and leg. As soon as the white blood cell count came down the pain would go away, when the count picked up it would be back. After the historectomy the count came down to almost normal and I was sent home. I still today have lots and lots of problems with my hip and my leg, can't sit crossed legged, can't sit stand or lie down for long periods without moving. No site that I have visited actually gives you information on what happens after this illness. Maybe you can look at doing something like this. —The preceding unsigned comment was added by 168.209.98.68 ( talk • contribs) 2006-07-25t11:02:37z.
This topic is in need of attention from an expert on the subject. The section or sections that need attention may be noted in a message below. |
-- Jeandré, 2006-08-08 t21:50z
Minor edit: When the infection crosses into sepsis, the symptoms of tachycardia, tachypnea, fever and/or decreased urination.
to
When the infection crosses into sepsis, the resulting symptoms are tachycardia, tachypnea, fever and/or decreased urination. DanMcScience 20:01, 17 April 2007 (UTC)
Post: Re: clear definition; septic; septicemia:
Sepsis is a medical term that refers to combination of conditions. If a person has those conditions, then we may refer to that person as "septic".
Understanding sepsis, and how it relates to infection is important because it can sometimes develop into severe, life-threatening illness, such as septic shock or multi-organ dysfunction syndrome, which are very often deadly.
The presence of sepsis requires that 2 things must be present at the same time:
The infection can originate anywhere in the body, but most often it starts in the lungs or in the urinary tract. Occasionally, it can be the result of a wound which then gets dirty, such as a gunshot wound, a surgical wound, or even a cut from broken glass, where bacteria or rarely fungus start to grow and multiply.
Normally, the immune system will contain the infection and destroy the offending bacteria right where they are. The area where the bacteria are multiplying may get hot, tender and red - this is evidence of INFLAMMATION. INFLAMMATION is tissue damage from a combination of toxins produced by the bacteria, and toxins produced by the immune system (that damage both bacteria, as well as surrounding tissue cells). If the infection is large enough, or lasts long enough, these toxins can enter the bloodstream by being absorbed into nearby veins. When this happens, it is called toxemia or septicemia (the suffix "-emia" means something "in the bloodstream").
These toxins travel through the bloodstream to distant organs and are responsible for making you feel sick, fatigued, achy, and nauseous. When they reach the brain in enough amounts, they signal the brain to raise the temperature of your body, and you will shiver uncontrollably. This is why people feel "chills" and experience what nurses and doctors call "rigors". Eventually your temperature will rise, and you will have a fever. This combination of fever, rapid heart rate, fast breathing is the body's response to a serious infection, and this is what we call SEPSIS. When this occurs, it usually means the infection is worsening.
Other changes can occur as well, some of which will only show as abnormalities on lab tests, such as increased white blood cell count, increased acid in the blood (acidemia), increased platelets, and an increase in certain proteins called "acute phase reactants". Doctors can test the blood and guess how severe an infection is by how severe someone's reaction to it is. Normally an infection will have to be quite severe or widespread before sepsis occurs.
However, everyone is different, and may react differently to the same amount of bacteria or toxin. Similarly, some bacteria produce very large amounts of or extremely toxic chemicals, that will mean sepsis occurs much earlier than in another case. As it progresses, you may experience more and more of the symptoms of sepsis, and they will become more and more severe. Hence, there are varying degrees of sepsis, from mild to severe. A person with a viral throat infection may have a rapid heart rate and a low-grade fever (less than 39 celsius) and feel fatigued. Their blood may have an increased number of white cells. Such a person could be said to be "mildly septic". This would be very different from someone with severe sepsis, who has a fever of 41, and a heart rate of 170 beats per minute, who is confused and delerious. That is to say, there are varying degrees of sepsis, from mild to severe.
To confuse matters, some people will NOT develop all of the signs or symptoms of sepsis before they progress to more severe forms. Many people, especially the very young and the elderly, for example, can even develop septic shock without ever having a fever. Some people take medications which slow the heart rate or suppress inflammation, which can mask some of the other signs and symptoms. Some people, such as organ-transplant recipients, have comprimised immune systems. It can be very difficult to diagnose sepsis in these cases. Usually however, there will be enough evidence for a doctor or other health care professional to recognize what is happening before things get out of hand.
Occasionally, the immune system will be unable to contain the bacteria before they leak into the bloodstream. This produces a very dangerous condition called bacteremia. The bacteria can lodge in distant organs such as joints, liver, kidneys, spleen, even in the heart valves. This can make it very difficult to tell where the original infection came from. It also makes the infection very difficult to treat.
This is more dangerous however, because it can activate the immune system in many places in the body all at once. However, you dont necessarily need bacteria in the blood to cause this. An infection can become so severe that large amounts of toxins are released into the blood stream. Usually by this time, however the blood will be colonized by the organism which caused the infection. widespread tissue damage, and affects the ability of the blood vessells to keep blood cells and plasma inside them. This will often result in a drop in blood pressure. When this happens, sepsis is said to be "severe sepsis". At this stage, unless the condition is diagnosed and rapidly treated, then death can be imminent. Doctors will often use intravenous fluids to raise the blood pressure of someone with severe sepsis. If this does not work, and the blood pressure stays below normal, the person is said to be in "Septic Shock".
When the blood and plasma begin to leak out of the blood vessells, they can no longer be pumped effectively to organs. Then, the organs no longer work properly and can produce even MORE toxic chemicals as they malfunction and their cells begin to die. This state is a further progression of severe sepsis and is called Multi-Organ Dysfunction, or MODS.
This response to inflammation, and progression to MODS is NOT always caused by infection: anyone with a serious allergy can attest that during a reaction, they feel as if their whole body is reacting similarly, and indeed it is. Doctors noticed over the years that regardless of the cause, there is a clear sequence of events following widespread activation of the immune system that can lead to death if not treated. Sometimes this progression halts itself, but the farther along you get, the less likely it will stop on its own. This is why doctors have carefully defined these terms and use them in a very specific way. It is vital to diagnose and treat infections before they progress to sepsis. Likewise, it is very important and recognize when someone is having a widespread immune reaction to something other than infection, a state called "Systemic Inflammatory Response Syndrome", or "SIRS".
SIRS can be caused by many things, including advanced cancer, trauma, burns, pancreatitis, severe allergic reactions (when it is called "anaphylaxis") and infection. When infection causes SIRS, we call that "sepsis". Sepsis and SIRS can lead to other things such as fluid in the lungs and the blood to spontaneously clot.
The Systemic Inflammatory Response Syndrome has a very precise definition, as does "sepsis" when it is used by doctors. Unfortunately, without understanding what SIRS is, the technical definition of sepsis is difficult to understand. Add to that the fact that most people have some idea of what is meant by sepsis, and it makes attempting a definition quite difficult. The definition of "SIRS" is at least 2 of the following 4:
The techinical definition of "sepsis", as used by doctors, is: SIRS, plus evidence of infection.
(adapted from --- American College of Chest Physicians: Society of Critical Care Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit. Care Med. 20:864-875, 1992)
What exactly is evidence of infection? Certain things are obvious, such as culturing bacteria from a normally bacteria-free site (such as blood, urinary tract, knee joint), or having signs or symptoms of common infections like pneumonia, bronchitis, and cystitis (bladder infection). However as many as half of people with severe bacterial infections will not grow bacteria from blood cultures, and most doctors can diagnose many common infections without even obtaining a blood sample. Consequently, this part of the definition is not agreed upon by every doctor. The best agreed upon definitions leave some room for error, by saying "strong clinical suspicion of infection" rather than "evidence of infection". Clearly, it is better to treat too much rather than too little when the stakes are so high.
To summarize, sepsis is widespread inflammation caused by your immune system responding to a serious (but not always life-threatening) infection. Sepsis is a special case of the more general condition, "SIRS". Sepsis can be very difficult to diagnose in the young, the elderly and those taking immune-suppressing medications. Recognizing it early is important because it can be deadly if left untreated. Even without causing death it can permanently damage organs such as the liver, kidneys, and heart. It may have other long-term effects, depending on the site of the infection, but these are more likely to be caused by the infection itself. Most people with sepsis will get better once the infection clears up; but it is important to be assessed by your doctor or other health care professional to find out for sure. 142.162.71.240 20:48, 20 June 2007 (UTC) CWR B.Sc, M.D. (Canada)
Does anyone actually use the term septicemia clinically anymore? Medline Plus basically states that it is synonymous with bacteremia with sepsis, which seems more to the point and less obfuscatory, and which I think should replace all instances of septicemia in the article. And septicemia doesn't fit the pattern for similar words like bacteremia, fungemia, or viremia, which basically denote something floating around in the blood stream (something + Gk 'emia' blood). If you say septicemia, what exactly is the thing that is floating around? Aswang ( talk) 20:14, 26 February 2008 (UTC)
Hi there, as an ITU nurse i can respond to this by saying that "Septicaemia" is very rarely used within the clinical setting.
Sepsis and Septic are used more widely to describe the huge spectrum of possible causes and as "Septicaemia" is actually directly related to blood poisoning it can lead to relatives percieving their loved ones to have a medical condition that they don't actually have. A person does not have to have bacteria in their blood stream in order to become septic. For example a great many septic patients become unwell from something as simple as a chest infection which does not respond to treatment at home, the infection then progresses quite aggressively and soon becomes a pneumonia. Not at anytime when blood cultures are taken is any bacteria detected in the blood stream. It must be highlighted that in most cases it is the bodies own reaction that causes a great many of the problems we face when fighting sepsis today. I fear that the piece is severely lacking a comprehensive "Physiology/pathophysiology" section and (even though i am quite new to this) i covered sepsis in some detail during my ITU course and would be happy to provide something if others to believe it would be helpful.
Septicaemia today is used (to the best of my knowledge) for the description of Bacterial Menningicoccal Spepticaemia as this is an infiltration of the blood by a highly fatal and aggressive bacteria. Septicaemia is characterised by discolouration of the skin due to the rapidly flowing toxins and with Meningicoccal infection can often lead to the loss of limbs due to the rapid cell death.
I would also like to add that it is documented that a respiratory rate of over 20 and PaCo2 of less that 4.3kpa is one symptom when in my practice it is a RR exceeding 30 that can severely compromise Co2 levels and that high Co2 levels are also indicative of sepsis. I do have many hundreds of references that may be of use but its 11 o clock at night and i have just finished a very busy late shift so you will forgive me for not having a moment to dig out the more useful ones right now, however if anyone feels i could be of use to this article then i would be happy to help (i have a huge facination with the topic).
It may also be useful to include something on the now hugely publisised Surviving Sepsis Campaign and Sepsis Care Bundles??? -- Basha440 ( talk) 22:16, 3 April 2008 (UTC)
I can only speak from the medical record coding side of things but we've had it drilled into us that bacteremia is simply an asymptomatic positive blood culture and sepsis requires evidence of SIRS. If the patient is symptomatic but those symptoms aren't serious enough to constitute SIRS then that is where septicemia lies and where the septicemia code alone should be used (In ICD-9 the dx of sepsis uses the combination of the codes for septicemia (038.x) plus the code for SIRS due to an infectious process (995.91)). Of course, you have to go by what the doctor actually documents rather than diagnosing things on your own - and doctors often have a terrible tendency to use the terms bacteremia and sepsis interchangeably).-- 209.7.195.158 ( talk) 16:20, 26 May 2009 (UTC)
Doesn't seem to be anything on here on what causes these contaminants to get in the blood. 67.189.104.78 ( talk) 07:24, 6 August 2008 (UTC)
Section implies that everyone who has sepsis dies in 6 month. Clearly not true. Milik ( talk)
Note the following sentence: "Septicemia (Also, septicaemia [sep⋅ti⋅cae⋅mi⋅a][3], or erroneously Septasemia and 'Septisema') is a related but depreciated (formerly sanctioned medical) term referring to the presence of pathogenic organisms in the bloodstream, leading to sepsis." I have practically no medical experience, but doesn't "depreciate" mean "reduce in monetary value; amortize" and "deprecate" mean "to phase out or recommend against use of"? To me, "deprecate" makes more sense in this sentence. Opinions? Thanks -- Jon vs ( talk) 07:05, 26 March 2009 (UTC)
The second half of the Epidemiology section seems to contain opinion statements, but I lack the medical expertise or documentation to make the appropriate changes. Opinion statements include "the (sometimes unnecessary) use of sedation", "which runs rampants (sic) in hospitals", and "often makes the beds of intensive care patients become death beds." -- 72.211.209.110 ( talk) 18:50, 22 April 2009 (UTC)
Blood poisoning redirects here; however, lymphangitis is also called blood poisoning. JN 466 18:53, 24 May 2009 (UTC)
What kind of picture is wanted? Doc James ( talk · contribs · email) 08:47, 7 February 2010 (UTC)
i had a papsmear done recently. and i was told that i had a very large number of white blood cell. they said it looked like some one took a cup full of wbc and poured it onto a slide. they were unable to tell me exactly what the cause was. they did some blood test and they all came back normal. i am scared that it may be something serious. can you tell me what i can do to find out exactly what is wrong? —Preceding unsigned comment added by 98.173.180.39 ( talk) 19:11, 15 April 2010 (UTC)
Someone added a request for citiation after the second set of units. I have removed the request. In my opinion, converting between cells/mm3 and cells/L is a trivial exercise and does not warrant a citation request. The relevant section of text is below:
-- Gak ( talk) 08:54, 11 June 2010 (UTC)
What's the deal with this? I am going to remove it. If anyone disagrees please reinstate it and explain.-- Adam in MO Talk 21:09, 18 November 2010 (UTC)
Is procalcitonin (PCT) testing not widely enough used in USA or elsewhere for sepsis rule-in or rule-out to be mentioned in this article ? - Rod57 ( talk) 15:43, 5 May 2011 (UTC)
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More References:
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link)Mike Turken ( talk · contribs · email) (If I write on your page, please reply on mine.) 02:02, 21 December 2012 (UTC)
What should we use in the lead? A picture of the meningitis rash. A picture of bacteria. A picture of the classification system [4] Doc James ( talk · contribs · email) (if I write on your page reply on mine) 03:48, 5 November 2012 (UTC)
Again, I highly suggest you change the picture of the baby's arms. It very disturbing and I'm sure there's a more appropriate picture out there. — Preceding unsigned comment added by 76.175.105.92 ( talk) 07:49, 19 January 2013 (UTC)
Dellinger, RP (2013 Feb). "Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012". Critical care medicine. 41 (2): 580–637.
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Doc James ( talk · contribs · email) (if I write on your page reply on mine) 03:30, 23 February 2013 (UTC)
Awesome! Thanks for posting this. And thanks for changing the photo, too.
Mike Turken (
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email) (If I write on your page, please reply on mine.) 21:00, 1 March 2013 (UTC)
doi:10.1164/rccm.201211-1983OC - not (yet) for inclusion, but postmortem results show that those dying from sepsis have cardiomyocyte injury and focal renal tubular abnormalities. JFW | T@lk 13:54, 1 March 2013 (UTC)
Observational studies have alluded to a benefit from statins, but most of the research is too weak to draw strong conclusions (says meta-analysis). doi:10.1186/cc13828 JFW | T@lk 19:58, 28 April 2014 (UTC)
Trying to incorporate new Surviving Sepsis Campaign diagnostic criteria into a table. Any thoughts about size/usability? Will edit text so that it's not so directly taken from the guidelines. But I also wondered if it might be more valuable to organize by kind of finding (physical exam vs. lab, or break it down by vitals). Thoughts?
General | Inflammatory markers | Hemodynamics and perfusion | Organ dysfunction |
---|---|---|---|
Fever >38.3C | Leukocytosis (WBC count >12,000/uL) | Arterial Hypotension ( SBP <90mm HG, MAP <70mmHg, or an SBP decrease >40mm Hg in adults or less than 2 SD below normal for age) | Arterial hypoxemia (PaO2/FIO2<300) |
Hypothermia < 36C | Low white blood cell (count <4,000/uL) | High lactate level (> 1 mmol/L) | Acute oliguria (urine output < 0.5 mL/kg/hr for at least 2 hrs despite adequate fluid resuscitation) |
Heart Rate >90/min or more than 2SD above normal value for age >38.3C | Normal WBC count with greater than 10% immature forms | Decreased capillary refill or mottling | Creatinine increase > 0.5mg/dL or 44.2 μmol/L |
Tachypnea | Plasma C-reactive protein more than 2SD above normal | Coagulation abnormalities (INR > 1.5 or aPTT > 60 s) | |
Altered mental status | Plasma procalcitonin more than 2SD above normal | Absent bowel sounds | |
Significant edema or positive fluid balance (>20mL/kg over 24hr) | Low platelets (platelet count < 100,000/μL) | ||
High blood sugar (plasma glucose>140mg/dL in the absence of diabetes) | Hyperbilirubinemia (plasma total bilirubin > 4mg/dL or 70 μmol/L) |
Mike Turken ( talk · contribs · email) (If I write on your page, please reply on mine.) 18:29, 30 April 2013 (UTC)
References
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Why do we need the NEJM blog [6] as a ref? When the full article is freely accessible here [7]? Blogs are not typically deemed reliable sources. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 20:26, 7 September 2013 (UTC)
I set it with the layurl parameter. - - MrBill3 ( talk) 08:08, 26 November 2014 (UTC)
I have uniformly formatted the references. For journals I have used last name, first initial with displayauthors set to 4. I used the full journal name and wl'd when possible. I have added urls to content available online. While the doi is more stable, a doi provides no clue if a subscription is required for a particular article. Where the url is not from the publisher I have added the via parameter to help resolve any copyright issues. To the extent possible I have completed the references, full author listing, pmid, doi etc.
If the authorship is attributed to a group(s), I used the group(s) as the first author. This isn't standard in scholarly citations but I think it is appropriate on WP. I made one exception where there were a multitude of groups all named in the title of the article.
I have also set up auto archiving for this talk page, 90 days, archive by number, indexed using ClueBot III.
I added a few update needed tags, one for a Cochrane review that has a more recent version and one for the Surviving Sepsis 2008 guidelines for which we should be using the 2012 guidelines (already a named ref in the article). Best. - - MrBill3 ( talk) 08:04, 26 November 2014 (UTC)
... after severe sepsis is logical but has been extremely poorly studied. doi:10.1002/jhm.2281. Probably can't be included as the review concedes that the research still needs to be done. JFW | T@lk 17:48, 19 November 2014 (UTC)
Angus, DC; van der Poll, T (August 29, 2013).
"Severe sepsis and septic shock".
The New England Journal of Medicine. 369 (9): 840–51.
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Doc James (
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Sepsis can be thought of as falling within a continuum from infection to multiple organ dysfunction syndrome. [1] Moved here as not really true. Doc James ( talk · contribs · email) 10:58, 28 November 2014 (UTC)
References
The section "Cause" could probably be improved. I have updated the reference, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases to the 8th ed. with a link to the chapter. The Google Books preview from my location allows the chapter to be read. I think the section does not represent what the source says precisely (this edition seems updated). It's great to see this important article getting some work.
As a side note, I can provide a single copy of the updated Cochrane article to an editor for improving this article via email. - - MrBill3 ( talk) 06:15, 29 November 2014 (UTC)
This "In 2006, following the Surviving Sepsis Campaign a set of medical therapies aimed at reducing the mortality rates from severe sepsis was developed by those workers involved in the campaign. These were named the Sepsis Six and consists of three diagnostic and three therapeutic steps – all to be delivered within one hour of the initial diagnosis of sepsis.
Deliver high-flow oxygen. Take blood cultures. Administer empiric intravenous antibiotics. Measure serum lactate and send full blood count. Start intravenous fluid resuscitation. Commence accurate urine output measurement.
The adoption of the Sepsis Six in centres in many countries has been associated with decreased mortality, decreased length of hospitalisation and days spent in intensive care units. [1]"
Is not supported by a good enough ref. Does not belong in the treatment section as half of it is diagnosis. And is already covered. Doc James ( talk · contribs · email) 15:27, 4 December 2014 (UTC)
References
Sepsis is SIRS plus infection. I think we need to keep the lead simple. Thus removed "SIRS can also be caused by other non-infectious conditions such as pancreatitis, reperfusion injury, or cancer." as this is in the body already. Doc James ( talk · contribs · email) 14:17, 6 December 2014 (UTC)