Tag Archives: Medical Conditions

Medical Conditions: Signs And Treatment Of Sepsis

Sepsis occurs when the body’s response to an infection damages its own tissues. When these infection-fighting processes turn on the body, they cause organs to function poorly and abnormally.

As sepsis worsens, blood flow to vital organs, such as your brain, heart and kidneys, becomes impaired. Sepsis may cause abnormal blood clotting that results in small clots or burst blood vessels that damage or destroy tissues. If sepsis progresses to septic shock, blood pressure drops dramatically, which can lead to death.

Nearly 270,000 people in the U.S. die each year as a result of sepsis, and one-third of people who die in a hospital have sepsis, according to the Centers for Disease Control and Prevention.

Signs of sepsis

To be diagnosed with sepsis, you must have a probable or confirmed infection, and all of these signs:

  • Change in mental status.
  • Systolic blood pressure — the top number in a blood pressure reading — less than or equal to 100 millimeters of mercury, or mm Hg.
  • Respiratory rate higher than or equal to 22 breaths per minute.

Signs of progression to septic shock include:

  • The need for medication to maintain systolic blood pressure greater than or equal to 65 mm Hg.
  • High levels of lactic acid in your blood, which means that your cells aren’t using oxygen properly.

Treatment

Early, aggressive treatment increases the likelihood of recovery.

A number of medications are used to treat sepsis and septic shock, including antibiotics, corticosteroids, painkillers and sedatives. Supportive care, including oxygen and dialysis, and surgery to remove the source of the infection, also may be needed.

People who have sepsis require close monitoring and treatment in a hospital ICU. Lifesaving measures may be needed to stabilize breathing and heart function.

Read more at Mayo Clinic

COMMENTS:

The hospital is a dangerous places to be, and the most common cause of death there is sepsis. Sepsis is an underappreciated killer, and it’s getting more common because people are aging, devices are more commonly implanted into the body, immunosuppressive treatment is being used more commonly, and hospital acquired infections are increasingly resistant to treatment.

Sepsis can be caused by an overwhelming infection with bacteria, but can also be caused by viruses, fungi, and severe trauma. Low blood pressure is a common  problem, and is associated with change in mental status, and increased breathing rate in raising a red flag for sepsis. Endotoxins play an important, if confusing, role. Endotoxins derive from Gram negative bacteria, but the most common bacterium causing sepsis is the gram positive staphylococcus aureus. With sepsis, though,the gastrointestinal tract may become more leaky, and Gram negative organisms may thereby gain  access to the blood stream.

A ccmmon test to detect sepsis is the serum lactate, which becomes elevated if oxygen utilization is diminished, such as in sepsis. There is also a direct test for endotoxin in the bloodstream, performed by using LAL, or Limulus amebocyte lysate. This substance, derived from the cells of the blood of the horseshoe crab, is very sensitive to endotoxins, and coagulates in its presence. This test is also used to detect endotoxins in Biological products and devices, making horseshoe crab is quite valuable.

Maintaining general health, keeping up on your immunizations, wishing your hands, keeping cuts and burns free from infection, ovoid smoking, controlling diabetes and avoiding hospitals whenever possible are useful preventative techniques.

—Dr. C.

Blood Circulation: What Is Raynaud’s Phenomenon?

Raynaud’s phenomenon: Not just poor circulation

When you’re exposed to a cold environment, your body reacts by trying to preserve your core temperature. Blood vessels near the surface of your skin constrict, redirecting blood flow deeper into the body. If you have Raynaud’s phenomenon, this process is more extreme, and even slight changes in air temperature can trigger an episode, says rheumatologist Dr. Robert H. Shmerling, senior faculty editor at Harvard Health Publishing and corresponding faculty in medicine at Harvard Medical School.

“Cold weather is the classic trigger for Raynaud’s phenomenon. But it can occur any time of year — for example, when you come out of a heated pool, walk into an air-conditioned building, or reach into the freezer section at the supermarket,” he says. In addition to the hands, Raynaud’s can also affect the feet and, less often, the nose, lips, and ears. During an episode, the small arteries supplying the fingers and toes contract spasmodically, hampering the flow of oxygen-rich blood to the skin. Some of these vessels even temporarily collapse, and the skin becomes pale and cool, sometimes blanching to a stark white color.

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #1 – THE “CHRONIC COUGH”

In my 88 years, I have had at least a dozen medical problems. Some have gone away on their own, some have been removed surgically, and a few have become CHRONIC, lasting for years, ultimately becoming a part of my life.

I have compiled a list of these and other SYMPTOMS & CONDITIONS I have seen as a physician. Over the next year, I will discuss them one by one, appending these vetted articles for further reading.

The ‘CHRONIC COUGH’ will be the first discussed.

As an Allergist, I was involved with coughing all of my adult life. If my patients did NOT have asthma, they usually coughed from mucus pouring down the back of their throat (post-nasal drip), from their allergic nasal condition (allergic rhinitis), or sometimes from the associated SINUSITIS drainage.

Asthma was a much more common cause of Chronic Cough for my Patients, sometimes theIr main problem. All asthmatic have a chronic inflammation of their breathing tubes(bronchi), and the resulting BRONCHITIS irritates the airway nerve endings, causing Cough.

Without enough narrowing of the airways to cause wheezing, this is called “cough equivalent asthma”. With the addition of airway narrowing (constriction) to the above situation, ASTHMA results.

There is added shortness of breath (dyspnea), and the cough becomes the “tight” wheezy cough of full-blown Asthma.

COPD (chronic obstructive pulmonary disease) may be a residue of long-term asthma, but commonly results from cigarette  smoking. Where loss of alveolae (air sacs) predominates, dyspnea (shortness of breath) is more common.

Where bronchial tube inflammation is more prominent, mucus and cough result. This cough is useful in clearing the mucus; a USEFUL COUGH (although my Patients did not always appreciate their friend, which could be bad enough to cause hernias or incontinence). 

Gastro-esophageal reflux is a chronic condition where stomach contents are not retained in the stomach by the G-E Sphincter ( a type of “purse-string” Gate), but spill(reflux) up, when not restrained by gravity, at NIGHT. The ACIDIC STOMACH CONTENTS burn the esophagus on the way up(heart burn), and are often aspirated into the airways during sleep, causing inflammation and COUGH.

There are many other less common CHRONIC LUNG ( pulmonary) DISEASES (conditions) such as sarcoidosis, bronchiectasis, interstitial pneumonitis, TB, and cancer, that can be diagnosed by imaging (X-Ray, etc.). Heart failure can also cause cough, as can blood pressure medication (ACE inhibitors). 

Smoking is an obvious cause; chronic smoking, chronic cough. Smokers know what is causing their cough, and usually don’t bother coming to the Doctor unless they cough up some blood, or develop one of the myriads of diseases caused by their habit.

If you have a chronic cough, check with your Primary Care Doctor, who may refer you to an Allergist or Pulmonologist. The following article will be useful to your understanding of cough, and will provide a LIST OF QUESTIONS the DOCTOR will likely ask you.

—Dr. C.

Further reading #1

Further reading #2