Ask any clinician which groups are most susceptible to sepsis and most of them will give you the same answer: the very young and the very old. Unfortunately, this means there’s a risk of complacency that could affect those who fall into the inbetween categories. Although it’s rare, failing to recognize sepsis signs in young adults can prove fatal.
What are the sepsis signs and symptoms people should watch out for?
According to the CDC, around 90% of adults who die from sepsis have an underlying health condition that makes them vulnerable to it. However, that means that there’s 10% who weren’t vulnerable, but somehow their condition is missed.
Recognizing the following sepsis signs is easy whether you have medical training or not:
- A temperature that’s too high or too low; This means one that’s above 100 degrees (or above 37.7 degrees Celsius) or below 96.8 degrees (36 degrees Celsius).
- A high heart rate; When a patient’s heart rate rises above 90, it isn’t always one of the key sepsis signs. However, when it occurs in line with other signs (especially low blood pressure) it becomes a red flag.
- A high respiratory rate; This means breathing more than 20 times per minute, as the body is trying to take more oxygen onboard as its immune system goes into overdrive.
- Reduced capillary refill; When you press on someone’s finger for five seconds and it takes longer than 2 seconds for the color to return from pale to red, that’s a warning sign.
- Unusual levels of fatigue
- Someone who becomes difficult to wake
- Cold peripheries (cold around the hands and feet)
- You’re aware there’s a potential source of infection
Although it’s worth mentioning signs such as sensitivity to light, unconsciousness, and a rash that doesn’t disappear when you roll a glass on it, they often arrive during the later phases of the infection. While it’s still possible to save someone at this stage, they may face long-term consequences due to a delay in recognizing sepsis signs.
What happens when you don’t recognize the signs quickly enough?
Most developed nations provide guidelines instructing doctors and other healthcare professionals on how quickly they should act when they spot sepsis signs. It’s often the case that the patient should receive broad spectrum antibiotics, high-flow oxygen, and IV fluids within an hour. Acting within that hour is crucial, otherwise sepsis becomes difficult to control. If you do prevent a fatality, they may face consequences such as a brain injury, gangrene, or losing limbs.
Here’s where things get a little challenging. Most of the early sepsis symptoms a doctor will encounter can represent other conditions. For example, the flu, a kidney infection that could be controlled with oral antibiotics, or a general viral illness. The very young and the very old are more likely to receive attention and rapid assessments because they’re immunocompromized. Therefore, when a clinician becomes aware that the lines between sepsis and an alternative illness are blurred, they’ll act rapidly.
As some studies recognize, identifying AND monitoring sepsis signs is clinically challenging. Although there’s been a slight rise in cases in the United States in recent years, there’s also been a decrease in deaths. In the UK, the picture is a lot murkier. There’s been an increase in cases, but also an increase in unnecessary deaths. A recent audit of different hospital areas in England found that many NHS trusts fail to fully screen patients for sepsis, despite having clear guidance on when they should do so.
Why is all of this important for young adults?
It’s probably worth mentioning now that when I say young adults, I mean anybody who ranges from their late teens to late-sixties. Which is very different to the young adults we think of when referring to fiction, for example.
Because young adults aren’t an at-risk group, there’s a risk that clinicians will drop the ball when screening for sepsis. Although experience counts for a tremendous number of positive actions in medicine, it also leads to complacency. If a clinician sees the key sepsis signs (high heart rate, low blood pressure, rapid breathing, and high temperature) but the patient appears clinically well in their judgement, they could attribute the signs to other conditions.
I’d like to argue that the increasing number of cases, plus the rise in deaths in the UK, means we need to maintain a high index of suspicion across all age groups. Yes, that index should remain higher for the very young and the very old. But, if there’s an infection simmering beneath the surface of a young adult and someone misses out on the golden treatment hour because they’re considering the likelihood of pain-induced signs versus sepsis, they’re risking causing a significant amount of harm.
As someone who is a big fan of reducing antibiotic resistance, I can appreciate the argument that unnecessarily introducing IV antibiotics comes with its own harms. But, it’s also worth considering which harms clinicians can reasonably reverse and which ones they can’t. If one of those 10% of healthy adults slips between through the net and spirals into septic shock, turning back time isn’t possible.
Or, clinicians can presume that there’s no dangerous clinical picture. Most of the time, luck (aka the patient’s immune system) will be on their side. When it isn’t, there’s a 15 to 30% chance that someone will lose their life, because sepsis signs were ignored on the basis that it’s the least likely cause.
Sadly, least likely doesn’t translate to not at all likely. Getting things wrong can either be embarassing or fatal. To steal a slightly juvenile phrase from the aviation world, it’s better to have a red face than a dead face.