Transcription:

Michael Carrese (Host):   The leading cause of death in U.S. hospitals and the most expensive condition to treat is something you might not know too much about. I'm talking about sepsis, which simply put is your body’s overreactive and toxic response to an infection. There's much more to it than that as you're about to find out. Welcome to Aspirus Health talk. I'm Michael Carrese. I'm here today with Dr. Chad Radke, a specialist in emergency medicine for Aspirus who’s going to be our expert guide on sepsis. Thanks very much for being with us.

Chad Radke, MD (Guest):   Thank you. Thank you for the opportunity to come talk about sepsis.

Host:  So let’s just dive right into it. What would you add to that very brief description I gave of sepsis?

Dr. Radke:   Absolutely. So sepsis starts as an infection. It can be commonly a pneumonia or lung infection. It could be a urinary tract or bladder infection. Skin infections are also quite common. So these infections start and then they escalate to the point where the body’s response becomes escalated and out of control resulting in weakness as a common presenting symptoms. Fever, low blood pressure, altered mental status. There’s definitely a cascade of mental symptoms that patients experience when a simple infection goes beyond, and the body’s response gets out of control and sepsis develops. Sepsis is a concept, as you previously mentioned, that is common in America and throughout the world, but doesn’t get as much attention as other disease processes that we hear about often like stroke or heart attack but is just as deadly.

Host:  So say somebody does recognize that they're in pretty dire straights along the lines of what you're just describing, and they get themselves to the hospital. What is it that you folks can do for them?

Dr. Radke:   The most important things we know about treating sepsis are early recognition and early antibiotics. So what we want to do as emergency physicians particularly is patients who come into the ER who have fevers, who have altered mental status, who are generally weaker than their normal status but don’t have signs of what we call an acute weakness such as an arm or a leg weakness we look for these signs of infection and sepsis. So we want to recognize that early. We want to start what we refer to as fluid resuscitation because one of the things that can happen is part of that exaggerated cascade of the body’s response to infection is the blood vessels become leaky and the blood pressure can go down and the body is struggling to keep up with that stress. So we give fluids and antibiotics as fast as possible to help the body recover from that stress that they are experiencing.

Host:  So for somebody who’s experiencing some of these symptoms, how do you know when there's a tipping point? How do you know when you really may be headed for major trouble? Is it just going to hit you like a ton of bricks, the disorientation you were talking about? Is the fever extraordinarily high? How do you know how much trouble you're in?

Dr. Radke:   I think that’s a great question. I think as all things in medicine, it’s a little bit different for everyone. I think the main point is that it’s very subtle or can be subtle for patients. Patients can develop fever and they can be managing that at home with Tylenol or Ibuprofen to control it, but then they can't get up or they can't get through their home. They're a bit confused. They don’t know where they are, they don’t know the month. They're talking about things that happened a long time ago. It go from there to what we call septic shock which is low blood pressure associated with the infection and this response. Then those patients have a high likelihood of having a bad outcome related to that.

Host:  I would think the disorientation and the extreme weakness would really be a tipoff that you need to get some help.

Dr. Radke:   Exactly right. That confusion, the inability let’s say to get out of a chair, fever, or weakness. Those are signs that people should seek medication.

Host:  Are there some kinds of people who are at higher risk for this?

Dr. Radke:   Absolutely. The main group we see this in commonly are patients who are at the extreme of age. So those that are old or young. Then those that are immunosuppressed or don’t have as good of immune systems as the average person. So that would be, obviously, patients who have transplants, those patients who may be on things like steroids or other biologic agents to reduce their immune system because they have a different chronic disease, diabetes, people with multiple medical problems. So if you take that as a whole, we really worry about patients who are elderly and then get an infection and have this syndrome that escalates out of control.

Host:  Are there kinds of infections that are more likely to lead to sepsis than others?

Dr. Radke:   So definitely the most common ones we see, particularly in the elderly, are pneumonias and urinary tract infections. Really any infection can lead to sepsis, but the most common ones would be a pneumonia or urinary tract infection.

Host:  Is there anything people can do to prevent this from happening?

Dr. Radke:   The main thing to do to prevent it is A, early identify it. So if you have a fever, you should be checked out. If you're starting to feel or have a loved one that’s confused or weak, that should be checked out or evaluated in the medical setting. The main thing is early recognition, early resuscitation with fluids, and the early antibiotics.

Host:  You mentioned that it’s not as common as heart attacks and strokes, and that’s why people may not be as aware of it as they should be. Just how big of a problem is it?

Dr. Radke:   This is a very big problem. It’s the most common cause, I think as you previously mentioned, of patients passing away in the hospital. Again at the older age the prevalence of patients who have it are much higher. I think that is particularly concerning in that the awareness of sepsis in the community is not equivalent or the same as the heart attacks and the strokes. We’ve had great campaigns alerting patients to signs and symptoms of those disease processes and that’s wonderful. We have not had the same campaigns to alert patients and loved ones about the signs to watch for. Most of these infections if they're recognized early are easily treatable in your home with early antibiotics. But when they escalate it requires admission to the hospital, IV antibiotics, aggressive fluid resuscitation, and it becomes a much bigger process.

Host:  So I'm also wondering how quickly can things go south here? Is this a situation where you start to feel some of these symptoms, but you’ve got a couple of hours before things can go downhill, or is this something that can come on really suddenly and you're in trouble quickly?

Dr. Radke:   Definitely—Again, there's a wide range of patient experience with this. Patients can definitely develop an infection, become septic, and have bad outcomes within a very short period of time, within 24 hours. So being alert to what your body’s going through and what your loved ones are going through and seeking care early is the key.

Host:  So you're talking about people who are gravely ill when they're in septic shock. I'm wondering how effective the treatments are for pulling them out of that.

Dr. Radke:   I think there's good data and research that says early antibiotics, aggressive antibiotics, broad spectrum antibiotics, and fluid can decrease patient’s mortality significantly. I'm going to sound like a broken record, but early recognition, those antibiotics to fight the bacteria that are getting out of control is so important in this process.  

Host:  So we’ve talked about public awareness being not where it should be on sepsis, but I'm wondering about people in the medical community. Are folks on alert for this? Are primary care docs and others as aware of it as they should be?

Dr. Radke:   I think in the past 15 years there's been a great push. I think everyone knows about sepsis through their medical training, but I think the focus on optimizing early recognition, appropriate antibiotics, meeting the criteria of what we call the ‘Surviving Sepsis’ campaign has really become a focus around the medical community. Providers are on top of this. Through the Aspirus system, I can tell you as the chair of our sepsis steering committee, this is an enormous quality focus for our hospitals. We focus on this and having great success implementing standardized care throughout the Aspirus system.

Host:  Well, it’s great to know you guys are on top of it. Really great to have you here today to provide all this really useful information about a problem that a lot of people aren’t aware of but should be. So thanks very much for joining us.

Dr. Radke:   Awesome. Anytime we can help.

Host:  You’ve been listening to Dr. Chad Radke, a specialist in emergency medicine for Aspirus. You can check out the latest information at aspirus.org. If you enjoyed this podcast, please subscribe and share it on your social channels. Thanks for listening.