Deborah Howell (Host): Hearing that you or a loved one may have sepsis is bound to raise a whole lot of questions and concerns. Dr. Garrett Luettgen and Stephanie Knewbow are with us today. Dr. Luettgen is an emergency medicine physician here at Pullman Regional Hospital, and Stephanie is the Emergency and Clinical Support Services Director. They're here to tackle our key questions about sepsis. Welcome, Stephanie, and welcome, Dr. Luettgen.

Stephanie Knewbow, MSN, RN: Hi. Thank you all.

Garrett Luettgen, MD: Thank you so much.

Host: The recent death of young race car driver Kyle Busch has brought sepsis into the national conversation, and a lot of people may have heard the word sepsis but may not really understand what it means. Can you explain what sepsis is and how it can become life-threatening?

Garrett Luettgen, MD: So, that case in particular does bring to public prominence a very important topic in a very unfortunate manner. Sepsis is what we doctors and other healthcare providers use as a technical term to describe the body's extreme reaction of severe and widespread inflammation throughout the body, which is most commonly in response to an infection. This can include acute organ dysfunction as well as instability of the body's circulatory system. Any organ can be involved in the particular malfunction, which includes the brain, the liver, kidneys, heart. And so, that means that sepsis can look very different depending on who the person is that is getting sick, as well as the kind of situation that person is in.

Commonly, the types of infections that end up developing into sepsis can include things like pneumonia, urinary tract infections, infections within the abdomen, as well as those of the skin and soft tissue. And we typically think of them as in response to a bacterial infection, but they also can be from things such as a viral or a fungal infection. And then, they can become life-threatening in the way that they develop because they can end up leading to tissue damage organ failure, and they can impair the body's ability to regulate and maintain its circulatory system, which comprise an entity known as septic shock.

Host: Right. We've all seen that on ER or, you know, Grey's Anatomy. So, I think people have some exposure to it. But how quickly can sepsis become serious, and what are the warning signs people should watch for?

Stephanie Knewbow, MSN, RN: Sepsis can progress quickly, and that's why early recognition is so important. When someone arrives to the emergency department, our team looks for signs that an infection may be causing a serious response in the body. The sooner we can identify that concern, the sooner we begin evaluating and treating the patient.

There is an acronym that can sometimes be helpful to patients, and that is TIME. So, T is for temperature, so a high fever or shivering. I is for infection, so signs of an infection like cough, painful urination. M is for mental decline, so confusion, sleepiness. And then, E is for extremely ill, so severe pain, discomfort or feeling really like something isn't right with your body.

Host: And what should somebody do if they think they or someone close to them might have sepsis?

Garrett Luettgen, MD: Because this can look so differently a-among different patient populations and within both very young as well as very old people, there's a very wide spectrum of what to be concerned about. It can be a little bit tricky to know exactly when to seek medical care. I would always encourage everyone to get symptoms that are concerning to them evaluated in a timely fashion.

If you think you have an infection, it's always advisable to try to get that looked at early before it becomes serious. But if the symptoms are such that a person is concerned that they may truly have sepsis, they need to be evaluated in the emergency department for swift medical evaluation and treatment if that becomes necessary.

Oftentimes, higher-risk populations that are in need of quicker evaluation include people that are over the age of 65, infants and children, and especially patients with either a weakened immune system or patients with chronic medical conditions such as diabetes or underlying lung disease; folks that are recovering from recent surgeries, or those with open wounds or burns. These are all things that should kind of indicate a lower threshold and an earlier recognition to get in and seek emergency medical care.

Host: So, should a person dial 911 or just go directly to the ER?

Garrett Luettgen, MD: It really depends on the circumstance that patient's in. If, for instance, you're having a hard time waking somebody up or if they seem acutely confused and you're not able to arouse them, then I would say that 911 is advisable. Or if they're having significant difficulty breathing, that's always a reason to call an ambulance. If they're able to walk and they're able to be up on their feet and you can safely get them in for emergency care, you can always bring them in yourself. But if you're concerned that they're truly having an emergency, 911 is always the right response.

Host: Excellent advice. What measures are being taken at Pullman Regional Hospital to catch and treat sepsis?

Stephanie Knewbow, MSN, RN: Sepsis is a time-sensitive condition. And so, early recognition and treatment can make a significant difference for the patient. But our patients don't always arrive with a label that says, "This is sepsis." Our goal is to make sure our team has a consistent process for recognizing when an infection may be causing someone to become seriously ill.

Our hospital is focused on strengthening how we identify patients who may be at risk for sepsis and how we communicate and respond as a healthcare team. Sepsis takes the whole team at the hospital. So, nurses may be the first to recognize that something's changing with the patient. Then, our providers will evaluate the patient and make decisions about their treatment. And then, we include many other departments as well, such as laboratory, respiratory therapy, and pharmacy to help us in the treatment of sepsis.

Host: Great. So, you're not working in a silo.

Stephanie Knewbow, MSN, RN: No, definitely not. We all work as a team.

Garrett Luettgen, MD: Emergency medicine and sepsis are very much a team sport.

Stephanie Knewbow, MSN, RN: Yes.

Host: Got it. What's one thing you wish that everyone in the community knew about sepsis?

Garrett Luettgen, MD: The medical community really has made excellent advances in sepsis care in the last 30 years, and we continue to try to refine our approach so that we can identify and treat sepsis cases earlier and treat them better. However, even with this, prevention still outweighs treatment. So, that means the best thing you can do to avoid becoming septic are trying to make sure that your chronic medical conditions are well managed, staying up to date on your immunizations, especially something like the pneumococcal vaccine and the flu vaccine, keeping your wounds covered until they are healed, and having your infections treated early. These are your best routes to avoid developing sepsis.

Host: Well, Stephanie and Dr. Luettgen, thank you so much for being with us today to enlighten us about sepsis. It's been such a pleasure to have both of you on the podcast.

Stephanie Knewbow, MSN, RN: Thank you.

Garrett Luettgen, MD: Thank you so much for having us.

Host: And for more info, you can visit pullmanregional.org/emergency. This has been The Health Podcast from Pullman Regional. I'm your host, Deborah Howell. Thanks for listening, and have yourself a great day.