Karen Loftus (Host): This is Community Connect: presented by Tampa General Hospital. I'm Karen Loftus. Joining me is Dr. Doug McConnell, a USF hospitalist and the Medical Director of Sepsis projects at Tampa General Hospital. Welcome to the podcast, Dr. McConnell.

Dr. Doug McConnell: Thank you. Good morning.

Host: In the past several years, you've taken a special interest in sepsis quality improvement initiatives, how hospitals identify and respond to sepsis, particularly in using technology and a sepsis detection system to help frontline staff.

Now, before we get into the treatment, recovery, and your work in sepsis care, let's start with the basics. So if people have heard the word sepsis, they may think infection, but it's a little bit more nuanced than that, right?

Dr. Doug McConnell: It is.

Host: Can you explain fairly high level what sepsis is and what's happening inside the body when it develops?

Dr. Doug McConnell: Yeah. So, the understanding of the infection is very true. You have to have an infection to get sepsis. But the word sepsis implies that that infection has caused effects throughout the body. And really, it's the immune system that is having an excessive and overwhelming response that causes problems in different organs, even outside where the infection is.

So, you could have effects with your liver, with your brain, with your heart, your kidneys. All of those run into major issues when the immune system goes haywire trying to manage an infection that isn't controlled.

Host: I gotcha. Now, sepsis affects more people than one might realize, yet it's not something the general population is talking about every day. What are some of the biggest misconceptions you hear about sepsis?

Dr. Doug McConnell: I think the biggest one is that—and this is among providers and clinicians and doctors too—is that to have sepsis, you have to have an infection in your bloodstream. That you have to have bacteria flowing through your blood to have sepsis, and that is very much not the case. That's one version of sepsis. Certainly, an infection in the bloodstream can cause that immune system overreaction. But really, that overreaction is the core of sepsis, and that infection can come from any location. So, patients with skin infections, pneumonia, infections inside their abdomen, all of those can end up with a sepsis diagnosis and have nothing to do with the presence of infection in their blood.

I think the other misconception that we see is that sepsis is a death sentence. And certainly, it has a very high mortality. We take it very seriously. And even when we do everything right, sometimes there are people that we can't save. But there is so much that we can do, and we have done at TGH to start to bend that mortality curve back towards saving lives, that I think doing everything that we do in terms of improving quality is very much worth it. So, sepsis is not a death sentence. There's a lot that we can do to save lives.

Host: And speaking about the work that you've done, you've worked extensively helping hospitals recognize sepsis earlier. Why can sepsis be so challenging to recognize, and what are some warning signs people should never ignore?

Dr. Doug McConnell: The problem with sepsis is that, especially early on, it can look like a lot of different things. In the past, we very much focused on changes in vital signs, so heart rate, respiratory rate, things like that, that would indicate that an infection is getting out of control. But those changes can come with a lot of different conditions and even normal physiology.

So if I had a patient run around the block, their heart rate would go up and their respiratory rate would go up. But obviously, they don't have sepsis, right? So, it's very difficult, especially in patients that have chronic illnesses, to differentiate what is the beginning of sepsis and what is normal functioning or another condition entirely.

Host: Let's say someone comes into the emergency department and sepsis is suspected. Can you tell us what happens behind the scenes and how does the care team work together to treat it quickly?

Dr. Doug McConnell: Yeah. So, the first step is trying to tease out, is this an infection and all the problems with sepsis related to an infection, or is this some other condition? And sometimes it can be even obvious by the story that brings patients to the hospital. You know, we don't want to miss things like a heart attack, but we mentioned vital sign changes. Obviously, that can look like sepsis in certain cases. So, the ER physicians that we have are adept at navigating the diagnosis process in the first place. They first try to understand, is there an infection that we need to work on? So, they're going to go looking for things like pneumonia, things like a urine infection or a skin infection. And that may be as simple as talking and listening to patients. But a lot of times, that goes with lab work and imaging.

So for instance, if we're thinking about pneumonia, we're going to want to listen to our patient, understand the symptoms that they had, hear what their lungs sound like, and then do an X-ray to take a look. If they find an infection and can then link that into signs that the immune system is overreacting, then we have a suspected sepsis case, and we have to react very fast. And that's where we see the greatest mortality gains is when we cross that bridge into a suspected sepsis case, we act very quickly to treat with antibiotics and get all the lab work that we need to understand how bad that sepsis case is.

Host: You talk about having to act fast, and with many medical conditions and emergencies, we hear that phrase that every minute counts. Can you go into a little bit more about why that rings true with sepsis when it comes to diagnosis and treatment?

Dr. Doug McConnell: So, acting quickly for sepsis is almost always centered around treating the underlying infection. What we know is that for a septic patient, having antibiotics quickly decreases their risk of ultimately dying in the hospital and not by a subtle amount. This is on the matter of hours decreasing their mortality percent by 5% or 10%. So, that is the number one intervention that we try to get done fast. But in the same process, we do want to make sure that we understand what that infection is and where it is. So, there's a lot of lab work that we have to do even before we start those antibiotics. There's a lot of resuscitation that we have to do, meaning getting patients' blood flow to all the parts of their body that need it to function appropriately.

A lot of septic patients have low blood pressure as a result of the immune system overreacting. So, we have to do things like intravenous fluids very fast on the matter of minutes and hours so that we don't have a patient sitting with poor perfusion out to their vital organs. And sometimes that even necessitates bringing patients to the ICU and doing medications that bring the blood pressure up directly. So, there's a lot in the first three and six hours that has to happen and takes a lot of coordination to get done correctly.

Host: Wow. Okay. So, supposing these interventions work and a patient gets through this immediate crisis, now what does the recovery look like? Is this something that people bounce back from quickly, or can there be lasting long-term effects?

Dr. Doug McConnell: Our hope is that we can minimize the long-term effects, right? That's why we try to identify early and we try to act quickly so that a patient who otherwise would have been very, very sick can have a relatively uneventful recovery. That being said, patients often do get very sick from sepsis, and they will end up in the ICU. They do end up on ventilators, breathing machines, on medications that will keep them confined to bed, or even just the illness keeping them confined to bed for a long period. So, even just the physical recovery can be surprisingly difficult. These are patients that spend a lot of time with our therapy teams in the hospital and then after the hospital, just trying to get strength back and get back to the function that they had.

I think the other side of that coin is the mental and emotional impacts that we're really just starting to understand in the last five and 10 years. You know, there are a lot of patients, especially after very serious critical illness with sepsis, who are subject to things like PTSD and anxiety and depression. There's a lot of emerging evidence about cognitive effects of being very sick with sepsis, and these are things that don't automatically revert to normal in just a couple weeks. These are impacts that can last for months and even years sometimes.

Host: Wow. Okay. So, I mentioned off the top just your work in moving this forward and improving outcomes. There were new sepsis guidelines that were released in 2026. For listeners who are not clinicians, what are some of the most important updates and how could they ultimately improve patient care?

Dr. Doug McConnell: The short version on the medical side is that we underline the emphasis that we knew about. We underline the importance of quick recognition, quick antibiotics, and resuscitating patients as fast as we can. There were some nuances that I think are more pertinent to ICU doctors and emergency room doctors. But the core backbone of sepsis care has not changed.

It just underlines the importance of things that we knew and how to get them done quickly. I think what deserves a mention is what we talked about with the emotional and cognitive and physical impacts long term. You know, we focus so much on saving lives and doing the right thing on the front end. But now, we're seeing the guidelines have increasing emphasis on the recovery and post-hospitalization care getting long-term resources for emotional and psychological impacts. It's actually nice to see the holistic take that these guidelines have had.

Host: Yeah, that sounds wonderful. Now, as we wrap up this conversation here, is there anything people can do at home to protect themselves and maybe help distinguish whether they need medical attention or not?

Dr. Doug McConnell: I think the best thing that patients can do at home is just look for signs that an infection is getting out of control. There's not so much that you can do to prevent an infection from occurring that most people aren't already doing with their doctors. But if you have an infection or might have an infection, understanding what sepsis looks like in the early phases is really important.

So, it's understanding when a fever is out of control for multiple days, when your heart rate is very elevated for you. Usually for most patients, we get concerned above the 110 or 120 mark, when your respiratory rate is up, if you're starting to get confused or disoriented, people are saying you're not making sense. All of those things in the context of an active infection, you should be seeing somebody or talking to somebody over the phone in pretty short order.

Host: Okay. Those are very helpful. Thank you so much, Dr. McConnell, for coming on our podcast and sharing your vast knowledge with our listeners.

Dr. Doug McConnell: Of course. I appreciate the audience. It's Sepsis Awareness Month coming up in September. So, this was perfect timing. Thank you.

Host: That has been Dr. Doug McConnell. For more information, please visit www.tgh.org/sepsis. If you enjoyed this episode, please be sure to like, subscribe, and follow Community Connect: presented by Tampa General Hospital on your favorite podcast platform. I'm Karen Loftus, and this is Community Connect: presented by TGH. Thanks for listening.

The content and information provided in our podcasts is for informational and educational purposes only and is not a substitute for professional medical care. Consult a qualified medical professional for diagnosis and treatment of any medical condition.