Sepsis and Medical Malpractice
Sepsis is an infection that has spread from a localized site, such as a bladder or upper respiratory infection, to the blood, affecting the body as a whole. Sepsis is a medical emergency, and can be life-threatening, because it causes an interruption of oxygen and nutrients to the body's vital organs. Anyone can develop sepsis from a localized infection, but it is most common in "susceptible" patient populations, such as those who are very young or very old, patients with a weak immune system, patients with severe wounds or traumatic injuries, patients with a co-existing drug or alcohol addiction, and patients with central venous catheters or indwelling urinary catheters.
Sepsis is becoming more and more common, especially in the hospital setting. The increasing incidence of sepsis is due in part to the widespread and increasing use of antibiotics, which encourages the growth of bacteria that are resistant to antibiotics. Drug-resistant bacteria require patients to be treated with stronger medications, usually association with more serious side effects than common antibiotics, such as liver and kidney failure.
Sepsis occurs in three different forms or stages, including uncomplicated sepsis, severe sepsis, and, most seriously, septic shock. Some patients will experience a progression of all three stages. Despite optimal care, some patients may not respond to treatment, and may develop multiple organ disease and eventually die. Importantly, however, delays in the treatment of a less severe form of sepsis can lead to progression to a more severe form, and even short delays in proper treatment can result in significant increases in mortality from sepsis.
Uncomplicated sepsis is very common and is experienced by millions of people each year. The majority of these people will not need hospital treatment. The Surviving Sepsis Campaign (http://www.survivingsepsis.org/Introduction/Pages/default.aspx) estimates that more than 750,000 individuals develop severe sepsis in North America each year. These patients require treatment in the hospital. Severe sepsis arises when organ system begin to fail as a result of sepsis. Patients with severe sepsis are more likely to die than those with uncomplicated sepsis.
Septic shock occurs when sepsis is complicated by low blood pressure that does not respond to standard treatment and leads to problems in one or more of the vital organs as described above. Despite active treatment in the ICU, the death rate is around 50%.
Most patients with sepsis have two or more of the following:
- Temperature greater than 38.3 degrees Celcius or less than 36.0 degrees Celcius;
- Difficulty with breathing and/or shortness of breath;
Warm skin, sometimes associated with a skin rash;
Rapid heart beat;
Generalized weakness and fatigue;
High blood sugar;
Elevated white blood cell count; and
Increased respiratory rate.
As sepsis progresses in severity, it can cause problems in virtually every other organ system of the body. Patients can experience breathing difficulty, a decrease in kidney function (including kidney failure), changes in blood clotting properties, a chance in mental status (i.e., confusion, strange behavior), a decrease in liver function (including liver failure). People who experience problems in more than one of their organs are said to have multi-system organ failure. Multi-system organ failure is associated with a significantly increased risk of death.
Sepsis can be caused by an infection in virtually any part of the body, but some locations are more common than others. The lungs, bowels, urinary tract, skin, and bones are common sources of a septic infection. In some cases, a source of the infection is never found.
Although there are evidence-based clinical practice guidelines available to help guide physicians' treatment of sepsis patients, many hospitals and doctors choose not to follow them. Unfortunately, even relatively short delays in receiving proper care can dramatically decrease a patient's chances for survival. Some literature demonstrates that for every hour delay in administration of the appropriate antibiotics, mortality increases by approximately 7%.This means that delays in diagnosis and treatment, even if they are relatively short delays, can cause severe injuries and might give rise to a claim for medical negligence.
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