HJBR Jan/Feb 2024

way to look at and measure the immune response to help make the diagnosis of sepsis, hopefully diagnosing it before the life-threatening consequence occurs, so that we can prevent the complications. The worst form of sepsis, called septic shock, occurs when the heart and vascular system is involved and unable to adequately deliver oxygen to the body or when the tissues of the body can’t use the oxygen that is delivered. The most common sign of septic shock is hypotension, or low blood pressure. What challenges exist in implementing sepsis care? Laperouse Patients present to emergency departments and clinics with symptoms, not diagnoses. Most patients having a heart attack present with chest pain. Stroke symptoms often include weakness on one side or difficulty speaking. Patients with sepsis do not present with any specific symptom. By definition, patients with sepsis do have an infection. Our job in the emergency department is to quickly investigate if a patient has an infection and how seriously it may be affecting their body. Vital signs such as temperature, heart rate, respiratory rate, and blood pressure give us some information but do not tell the whole story. Historically, we have not had a good test to evaluate for sepsis (i.e., EKG in chest pain). We had to presume patients were sick with sepsis and initiate tests and treatments such as antibiotics and IV fluids. Most of these patients had to stay in the hospital until we had more information. Now, with IntelliSep, we have a test that can be run early. It gives us more information to risk stratify who likely has sepsis and who likely does not. We can treat accordingly and even send patients home when appropriate. What are the current guidelines for treating sepsis? Thomas The current guidelines for treating sepsis rely on several key elements. First, early suspicion with accurate identification is critical to any treatment strategy. After suspecting sepsis, treatment involves the early and rapid administration of antibiotics and monitoring for low blood pressure known as shock. If shock if present, intravenous fluids are used to raise blood pressure, paired with other medications known as vasopressors that help the heart and vascular system respond. Finally, teams reevaluate patients often in sepsis through a combination of lab tests such as lactic acid and physical examination to determine response to therapy. Does OLOL have a specialized sepsis rapid response team focused on managing patients with sepsis? If so, how does it operate? Laperouse Not all patients with sepsis appear severely ill from the onset. We no longer solely rely on a symptom and vital signs. With a blood test to risk stratify for sepsis available in the emergency department at Our Lady of the Lake, we can focus our attention on the sickest patients. IntelliSep helps us to identify those patients that are most likely suffering with sepsis and those that are not. When a “critical result”is called from the lab, we announce a “sepsis alert” overhead. All responsible parties, such as nursing, physicians, and pharmacy, respond to the patient whether in a room or still in the waiting room to ensure all appropriate care has been initiated. What is the current state of antibiotic-resistant infections? How concerned are you about these infections, and is there a viable solution? O’Neal Antibiotic resistance is a problem worldwide, and we are very concerned by it. Because sepsis is the result of an abnormal immune response to an infection, treating sepsis requires curing the infection, or what we call “source control.”In the case of bacterial infections, gaining source control usually requires antibiotics. If the bacteria is resistant to antibiotics, it can be difficult or, in the extreme, impossible to gain source control. Antibiotic resistance is a direct effect of using antibiotics. In fact, Alexander Fleming, who discovered penicillin, warned us in his Nobel lecture about developing antibiotics in the case of inappropriate penicillin use. The pathogens are smart, and they figure out a way to exist in the setting of antibiotics.The best way to solve the problem of antibiotic resistance is to only use antibiotics when it is absolutely necessary. Many common “Alexander Fleming, who discovered penicillin, warned us in his Nobel lecture about developing antibiotics in the case of inappropriate penicillin use. The pathogens are smart, and they figure out a way to exist in the setting of antibiotics.”