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38 m a s s a g e & b o d y wo r k n ove m b e r/d e ce m b e r 2 0 2 1 Sepsis The Hidden Crisis By Ruth Werner, BCTMB education | PATHOLOGY PERSPECTIVES "I'll take Unrecognized Life- Threatening Emergencies for $62 billion in hospital costs, Alex." "This condition is diagnosed 1.7 million times a year in the US, and it causes one out of every three hospital deaths. About 2.5 million people are survivors, and they have a lifelong increased risk for serious complications." "What is sepsis?" "That is correct!" For such a common situation, sepsis is surprisingly poorly understood by many, and frequently escapes early detection until the patient is very ill. This is why sepsis is a leading cause of hospital deaths and the main cause of hospital readmissions. WHAT IS SEPSIS? Hippocrates used the term sepsis in the 4th century BCE to denote decomposition of tissues. In modern usage, the word implies infection; its antonym, antisepsis, of course refers to actions taken to prevent infection. Until recently, the terms sepsis, septicemia, and blood poisoning were used more or less interchangeably. Then in 2016, a group of experts gathered to clarify some of the nomenclature around sepsis and related disorders. Along with these classifications, they also proposed some diagnostic criteria and screening tools based on various tests that are outside our scope of practice. Together, these labels and criteria have helped health-care providers improve outcomes for patients with sepsis. (See Sepsis Nomenclature sidebar.) infection. This situation is called systemic inflammatory response syndrome (SIRS). SIRS can be triggered by sepsis, but it can also be the result of pancreatitis, severe trauma, allergic reactions, cancer, or other causes. Close study of the inflammatory and immune system activities in both sepsis and SIRS has confirmed that these processes are similar; the main difference is the presence or absence of a pathologic trigger like a bacterial or viral infection. Both sepsis and SIRS can lead to pathologic clotting in the blood vessels that supply the limbs and organs, which can cause tissue death and gangrene. This accounts for about 10 percent of all amputations that happen in the US each year. PATHOPHYSIOLOGY OF SEPSIS At one time it was assumed that sepsis was the result of uncontrolled spread of pathogens throughout the body. Then, as we became more knowledgeable about the inflammatory process and immune system activity, we came to understand that infection is only one aspect of sepsis, and that it is more accurate to describe this situation as a "life-threatening organ dysfunction caused by a dysregulated host response to infection." 1 In other words, sepsis is not a synonym for infection. Rather, it is the result of infection, immune system activity, and inflammation that together lead to organ damage, organ failure, and death. (Interestingly, this is the same triad of features that makes COVID-19 so dangerous to some patients.) It is worthwhile to point out that organ failure related to immune system activity and inflammation can also happen without

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