Sepsis – ‘The rise of the silent killer’

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This morning on the news there was an article about Sepsis and some poor guy who ended up a double amputee due to a cut gained playing with his dog. If you’ve never witnessed sepsis first hand, I think it’s hard to appreciate how scary it is. Common signs and symptoms of Sepsis can include fever, increased heart rate, increased breathing rate, and confusion. It can often just seem like flu (real flu, not I’ve got a runny nose, I’ve got flu) or me with a hangover. I shouldn’t joke, it’s a super deadly condition. The risk of death from sepsis is as high as 30%, from severe sepsis as high as 50%, and from septic shock as high as 80%.

While Sepsis is a rare complication of infection, it’s one that many of our cardiac kids have had to fight. Isla’s battled it twice and had suspected Sepsis once since leaving hospital. Sepsis is sometimes mis-called blood poisoning, but Sepsis is not just limited to the blood but can affect the whole body, including the organs. Similarly, septicaemia (the other term sometimes used) refers to a bacterial infection of the blood; whereas sepsis can also be caused by viral or fungal infections.

Sepsis probably isn’t so rare in our cardiac world due to the fact that 1. Lots of children have had their chests open at some point and so are very susceptible to infections 2. They have lots of plastic lines and tubes going in and out of them and bacteria loves a bit of plastic!

On ICU Isla’s arterial line began to grow bacteria somewhere along the way. It’s not particularly surprising therefore that she was vulnerable as the bacteria had motorway access to her bloodstream. I wasn’t particularly aware of it at the time; I was new to the medical world and there were lots of machines and medical jargon. The fact she was on ICU and having regular bloods done meant that it was caught very quickly and broad spectrum antibiotics could be given almost instantly. She also had a central line infection, I have a feeling that one came first but like I said, back in the first few weeks I was relatively clueless.

Isla has had to be shocked back to life 3 times. I witnessed one of them. It was terrifying. I think seeing Isla fighting Sepsis on 1C was up there with the scariest things I’ve been through.

At the time Isla had a Broviac line (secure IV access pretty much straight to the heart). Although surgically inserted, any line in is an infection risk. Even though the line was looped it still dangled down a fair way, mainly because she had such a little body!

The problem came when Isla had a particularly bad Poonami. This is something google (from the motherload) defines as:
[Poo-nah-mee]
A monumental infant bowel movement of such quantity and consistency that no nappy stands a chance of containing it, resulting in a disastrous mess.

Normally a poonami is a category brown level for any parent. It requires a full clean up crew wearing hazmat suits and a 10 metre radius decontamination. It is prudent in these events to incinerate any clothes worn by baby and yourself and then seriously consider your life options.

Combine a Poonami with a dangling central line. No amount of cleaning and changing the port on the line could have prevented what I can only imagine as a stream of poo straight to the bloodstream. Nobody wants that. I do remember the nurse who was on that day spent a long long time cleaning the line and sterilising everything before changing the port. As the definition states though, disastrous mess… disastrous consequences. What was there to potentially save her life, was now the biggest threat to it. I can’t honestly remember how long after the poonami things went down hill. In my mind it was the next day, however, I remember that day vividly.

We had just given Isla a bath prior to weighing her. Her nurse was wiping down her cot and equipment and had changed her bedding. We got Isla out of the bath and we commented she was a bit mottled and she was shivering. We put this down to her being cold from coming out of the bath. The nurse did her temperature; it was normal. However, within minutes, yes literally minutes, everything changed. The speed at which she went downhill was terrifying. Within 5 minutes her heart rate was 150, her temperature was rising by the second, she was mottled and shivering. It became quite apparent something was very wrong. I honestly hate to think what would have happened if we hadn’t been in hospital and the staff weren’t as quick thinking and amazing as they are! Put simply, if we had been at home, she be dead. Things went wrong that fast.

We were on the Green pod of the ward where staffing ratios are 1:4. Isla’s nurse that day was incredible and she called in the reinforcements. It was almost akin to the day when I first saw Isla in Alder Hey in ICU. It seemed as though every member of staff in the hospital were there just for Isla. We were quickly moved to the HDU blue pod, with talk of moving to Critical Care HDU.

Isla’s heart rate sat between 160-180, she suffered countless seizures (literally countless as we gave up recording them on her chart), her temperature stayed above 40 despite regular paracetamol. I genuinely feared the worst. This is where having friends around to bring you a cup of tea and provide sugary sweets was a godsend. I’m pretty sure having friends when in hospital is a significant contributor to diabetes but you do what you can!

Isla was very quickly prescribed Meropenum, which is a broad spectrum antibiotic, basically bleach for the immune system. The junior doctor on the ward that day was amazing. She stayed well beyond the end of her shift to wait, constantly refreshing the computer for the lab results to find out the exact bacteria that was causing the problems, so she could prescribe the best antibiotic. It took a few days of IV antibiotics to get Isla back to her happy little self.

North West hospitals are getting a bad press for Sepsis but from my experience, Alder Hey are incredible when it comes to Sepsis awareness and Bolton have treated Isla for suspected Sepsis before, starting antibiotics as a precaution even before the blood cultures came back. Both have ‘Think Sepsis’ signs around. It may be being called ‘the silent killer’ on the news. It can’t be silent if we shout about it though. Sepsis awareness week or month or whatever made up time of the year it was is gone, it’s been replaced with ‘Spray paint a badger week’ or something, but I urge anyone reading this to have a quick read up on Sepsis and just have it in the back of your mind. That and a good poonami. Don’t forget poonamis.

p.s. Please don’t spray paint badgers

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