A guest blog by my fabulous friend, Val Finigan
‘I had an idea-to write a little blog every few months that would help the midwives and nurses at gtdhealthcare with their continued professional development needs, in preparation for revalidation.
So here goes, my first blog on sepsis. I hope that you all enjoy it –please do comment if it is of use.
The idea of blogging is to share ideas and to embed ‘things’ into the blog that make shared learning easy. Story telling has become an important part of learning in healthcare. Here I will share my two personal stories of sepsis and links to evidence based learning tools and red flag symptoms of sepsis.
Sepsis is more common than a heart attack ! Isn’t that shocking?
The 2015, NCEPOD report, ‘Just Say Sepsis’, Identified an overall mortality rate of 28.9% per annum, at least 120 people die every day from sepsis in the UK alone.The sepsis manual 2017 (embedded) says “it seems highly likely that, across the UK, sepsis claims at least 46,000 lives every year, and it may actually be as high as 67,000”. Who would have thought that the figures would be this high?
Sepsis that occurs during pregnancy is termed, ‘maternal sepsis’. If it develops within six weeks of delivery it is termed postpartum or ‘puerperal’ sepsis. Sepsis is one of the leading causes of direct maternal death in the UK. See maternal sepsis tools in the Sepsis manual 2017 (below).
The HEE have developed a wonderful e-learning programme on sepsis which can be accessed via the web link below.
They have also produced a short film that is really helpful
Sepsis is a condition which every health professional might encounter, and which can touch anyone at any time. In general, patients developing sepsis aren’t ‘labelled’ as being at high risk for that condition (in comparison with, for example, a majority of patients presenting with acute severe asthma or diabetic ketoacidosis). There is no one ‘hallmark’ symptom or sign, unlike the crushing chest pain which the public know might indicate a heart attack.
Because of this, patients tend to present to healthcare late, as evidenced by a 2015 report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) which found that, where patients were felt to have presented late to hospital, in nearly 60% of cases it was because they did not ask for help and the delays were typically measured in days rather than hours.
The National Institute for health and healthcare excellence (2017) have also published guidance on the prevention and management of sepsis- to take a peek CLICK HERE
I have had two personal experiences of sepsis, in the days when little was known about the condition.
My first child had sepsis and septic arthritis at the young age of 7 (29 years ago). She had suffered with recurrent Tonsillitis for two years and had been treated with numerous courses of antibiotics. She developed severe pain in her hip and over the next five days became increasingly ill. An initial xray revealed nothing and because there were not hot spots seen, her symptoms appeared to become irrelevant; the hospital staff would not listen to me nor would my GP. Although I took my daughter on many visits to the GP and Accident and Emergency Department nothing was done. In fact I was labelled as an over-anxious mother and directed to the paediatric pain services to learn to control my daughter’s ‘discomfort’.
On the 5thday of her illness she was hallucinating, confused,her temperature was 35C and she was mottled and cold to touch, her lips were blue. I took her straight back to Accident and Emergency. Two hours later she was in theatre and then spent 6 weeks in hospital on traction and two weeks on intravenous antibiotics, her reminder a scar from thigh to knee.
The final diagnosis came, Sepsis and severe Septic arthritis of the hip.
We counted our blessings daily; if I hadn’t been the awkward mother the outcome could have been worse. The hospital offered their sincere apologies and lessons were to be learnt.
One lesson I took from this-was always take note of what the parents are saying after all they know their child better than you do.
My second child had sepsis years later. Age 11 years; his tooth was broken when he was hit accidentally with a cricket bat. The tooth was crowned and the temporary crown kept falling off. Sepsis was quick to bite (pardon the pun).
This time there was a more rapid onset of symptoms. My son came in from playing out and said he felt unwell; he was shivering excessivelyand looked pale and mottled. His temperature was high, yet he sat firmly besides the warm hot radiator because he felt cold. I took him straight to Accident and Emergency and the staff in this department were trained to spot signs of sepsis.
Immediately bloods were taken, he was admitted and intravenous antibiotics were were administered within an hour of our arrival at Accident and Emergency. Two weeks later we were back home with a well child.
So what can be learnt from these two examples of sepsis? The symptoms can be variable –take a look at spotting sepsis below. The onset can also be variable. There are red flag symptoms, early assessment, diagnosis and management are vital.
I hope that the tools in this blog are helpful and that it has been useful. Please do comment
Thank you for taking the time to read it
Val Finigan July 2018
RM. IBCLC. RGN. PhD. MsC. BA (Hons). FHEA. QTLS. Honorary research fellow, senior clinical nurse gtdhealthcare