Issue link: https://www.massageandbodyworkdigital.com/i/1417136
L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 39 Sepsis Nomenclature • Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. • Systemic inflammatory response syndrome (SIRS) is similar to sepsis, except that it can be caused by noninfectious problems. • Multiple organ dysfunction syndrome (MODS) is the result of sepsis. It can affect several body systems. • Septic shock is a subset of sepsis, with dangerously low blood pressure and several other abnormalities. Septic shock poses a greater risk of death than sepsis alone. • Bacteremia refers to a bacterial infection of the bloodstream that could lead to organ damage. (Note: Viruses and fungi may also infect the bloodstream.) • Pseudosepsis involves fever, hypotension, and other signs that are easily mistaken for sepsis, but are not the result of infection. SEPSIS SIGNS AND SYMPTOMS One of the truly scary things about sepsis is how quickly a person can go from feeling fine or only mildly "off" to being in end-stage organ failure or at risk for losing a limb. In the video that accompanies this article, I describe sepsis experiences shared with me by two massage therapists. The stories are very different, but the thing they share is the suddenness with which the extreme and dangerous consequences of sepsis hit. Because sepsis is not directly linked to the presence of pathogens or white blood cells in the bloodstream, it can be difficult to identify early, especially outside a hospital. Some specific diagnostic criteria have been created, but they require tests and screens that are available only in emergency health-care settings. General signs and symptoms can (but don't always) include fever, impaired mental status, increased respiration, warm or cold skin, and low blood pressure. However, a handful of other serious situations can mimic sepsis, including dehydration, gastrointestinal bleeding, diabetic ketoacidosis, pancreatitis, pulmonary embolism, and others. Some patients' blood pressure dips very low, causing septic shock: a situation in which organs can fail because of lack of blood supply. Septic shock is very serious, and it has a higher risk of mortality than sepsis without hypotension. A mnemonic for sepsis symptoms ("TIME") is promoted by an organization called the Sepsis Alliance (see It's About TIME graphic, page 41). This protocol can help get people at risk to emergency services where they can be evaluated for the risk of sepsis. TREATMENT Sepsis is treated with antibiotics, rehydration, and medications to stabilize blood pressure. Other treatments depend on the initial cause of the sepsis, but just getting stabilized can take enormous time and resources. It is not unusual for patients who survive sepsis to stay in the hospital for a week or more. POST-SEPSIS SYNDROME Sepsis is a life-threatening situation with subtle early signs and a risk of permanent organ damage, amputation, and death. For those who survive, their struggle may not be over. Many people who survive sepsis go on to develop post-sepsis syndrome (PSS). PSS can involve long-term physical, psychological, and mental disabilities. Patients report problems with memory, learning, and decision-making. PSS is associated with fatigue, pain, muscle weakness and wasting, posttraumatic stress disorder (PTSD) symptoms, chest pain, shortness of breath, insomnia, depression, anxiety, and more. (Does this sound familiar? The same symptoms are associated with chronic fatigue syndrome and long COVID—two other post-infection situations.) And PSS is common. Improved early recognition of sepsis and more effective treatment options means the number of sepsis survivors is increasing. This is good news, of course, but it also means that the number of people with PSS is increasing, and there are no established effective medical treatment protocols for this population. IMPLICATIONS FOR MASSAGE THERAPY Massage therapists are unlikely to see clients with acute sepsis, but it's not impossible. And the signs and symptoms of this condition are variable, unpredictable, and often not immediately indicative of a system-wide, life-threatening infection an inflammatory reaction. If fever is present, that is an obvious reason to cancel an appointment and refer the client to a primary health-care provider. But not all people with active sepsis have