Sepsis and Septic Shock

Many infections that patients get do not result in severe illness requiring the ICU. Pneumonias, urinary tract infections, and GI bugs pass through clinics across the world each day without a thought. A few unfortunate patients develop a clinical syndrome that is much more severe called sepsis. This is the term that physicians use to describe an overwhelming infection that has made a patient very ill. Treating these patients can be a complex process. Here is some insight into what physicians are considering when they see a patient with sepsis.

Sepsis and the Infectious Continuum

Doctors are very detail oriented by nature. To that end, we classify everything in order to better understand things. For severe infections, there is a continuum of disease ranging in severity from your basic infection like a urinary tract infection all the way to the most severe, septic shock. This spectrum may seem a bit like voodoo, so here is a simple breakdown:

SIRS (Systemic Inflammatory Response Syndrome)-patient has two or more of abnormal temperature, heart rate, respiratory rate, or white blood cell count (blood test)

Sepsis-Has SIRS plus a known site of infection

Severe Sepsis-Has sepsis plus dysfunction of at least one organ

Septic Shock-Has severe sepsis plus low blood pressure

Antibiotics and Other Medications

The mainstay of therapy for anyone with a severe infection is antibiotics. Common sense would tell you that giving antibiotics quickly probably makes a difference. As a matter of fact, it does. There was a study published in Critical Care Medicine that showed giving antibiotics more quickly saves more lives.

In addition to giving antibiotics quickly, there is a protocol known commonly amongst physicians as Rivers Protocol. This is named for the lead author on the article appearing in The New England Journal of Medicine that first outlined this approach. The general idea is that antibiotics are given quickly as well as other interventions (fluids, medicines to sustain blood pressure, and blood) to sustain the patient while they are in the acute phase of their illness. This is why things seems to happen quickly at first when someone goes to the ICU. There is usually a well planned out protocol for the first few hours.

Ventilator

It is not uncommon for a patient with sepsis to require the ventilator for a period of time, especially if the patient's infection started as a pneumonia. Putting a patient on the ventilator relieves the patient from the work of breathing and ensures that their respirations continue in a controlled manner. By taking control of this essential function, doctors can use other medications and interventions described above to get the patient on the road to recovery while ensuring that the patient's lungs continue to work. As a side effect, patients must be sedated while on the ventilator because of the invasive nature of having a tube in your throat, which means they won't remember much of being on the ventilator. Once they begin to improve, they can be weaned off the ventilator and have the breathing tube removed.

Long Term Health Effects

Because of the debilitating nature of having sepsis, many patients find it takes them weeks or even months to recover their strength. This is especially true for elderly folks or those already weak from chronic illness. Many ICUs will get physical therapy to see patients even while they are still in the ICU. After getting appropriately treated, some patients require time at a rehab facility to regain their strength before going home. While most want to get home quickly, patients often find that they are eventually appreciative of going to rehab as they would not have had the strength to function at home without it. There's nothing like getting out of bed to make a person feel better!

120 Days in Intensive Care

I want to talk about another real world example of what some long-term Patients and their Families are going through, when faced with long-term ventilation with Tracheostomy in Intensive Care.
A long-term Patient in Intensive Care died after around 120 days in Intensive Care. A very tragic case that would have ended with the same outcome and in a nicer and more Patient and Family friendly environment, if people would think outside of the box and outside of their current clinical paradigms. In this instance- thanks to a few courageous people- a few steps in the right direction have been taken. Those steps, from my perspective, were quite unusual in the current Intensive Care paradigm, but made a big difference to the Patient and the Family and have the potential to be taken further in the future, but I'll talk about the specifics later.

The Patient was ventilated and had a Tracheostomy pretty early in the ICU admission due to the Patients underlying clinical issues and premedical history.

After around day 60, the Patient- as so many long-term ventilated Patients in Intensive Care- lost strength, vitality and was rapidly deteriorating, although the Patient never lost faith and had been very positive generally, despite being in a cubicle with limited privacy and dignity. The Patient was extremely brave, despite the destiny the Patient was facing, as after around day 60, so many long-term ventilated Patients and their Families usually lose patience, stamina and faith in the ordeal they are going through. Usually Patients become clinically depressed, due to the environment they are in and they suffer from a disturbed day and night rhythm with sleep deprivation. How can one sleep in a busy, high stress, 24/7 environment anyway? I have yet to find the answer to that one...
The Patient was generally clinically stable and the main issue keeping the Patient in Intensive Care was the ventilator dependency. The Patient was ready to fight the odds, but also realised after around day 90 the limitations of what modern medicine is able to provide and that our time on this earth is limited. It was around the day 90 mark when the first discussions about palliation and withdrawal of treatment were raised and the first Family meetings were held around the issues of palliation and withdrawal of treatment. Mind you the Patient was only in its mid fifties and far too young to die, let alone spending the last few months in Intensive Care with no Quality of Life...

The Patient had limited support from immediate Family- not because the Family did not want to support their loved one- However, the Patient's spouse lived far away and also suffered from a stroke in the last 6 months. The Patient's spouse was therefore only able to visit once a week. Probably not quite a visiting pattern that fully supports a critically ill Family member in Intensive Care...

The Patient also had adult children and they had young children of their own and the children therefore had serious time constraints to support their parent through the ordeal in Intensive Care.

Discussions around end-of Life Care, palliation and withdrawal of treatment are never easy, and especially if Patients are awake and understand the implications of the decisions being made, the Patients view should count as well. The Patient and the Family were having a very difficult time to confront the end-of-Life situation, as the Patient and the Family were desperately and understandably trying to hold on to a young life.

The sad thing about the story is that, like in so many other cases that I have witnessed over the years in Intensive Care, everybody working in the environment knows that some Patients are going to die over sometimes weeks and months and Intensive Care is not an environment where people want to die, if given a choice. Especially if Patients are awake, why would we as health professionals leave them in a busy, noisy and stressful Critical Care environment, if there is another option available, that would not only provide the Patients, but also their Families with a much better Quality of (end-of) Life? Why do Intensive Care Units continue to occupy their beds with long-term Patients, spend hundreds of thousands of Dollars of tax payers money, when there is another more cost effective solution that also frees up scarce ICU resources(staff and beds) that could be used for more acute Patients?

Continuing with the Patients ordeal, during the last two weeks of the Patients stay in Intensive Care, more Family meetings were held, until it was decided that the Patient was going to be palliated. Around 48 hours prior to the Patient being palliated, the Patient had the opportunity to go home for a visit whilst being ventilated. This was made possible thanks to a few courageous health professionals within the Intensive Care environment. That gave the Patient and the Family a few hours together in their Family home. The Patient was able to visit the Family home one more time and say goodbye to the house and to the pets that lived there... This was good news for all parties involved, if there were any good news at all, in such a difficult situation. The Patient went back to ICU and passed away within the next 48 hours.

But why do Intensive Care Units still wait for 60 or 90 days and longer in order to provide a Patient and their Families with what they really want, really need and provide them with a better Quality of Life and/or Quality of-end-of-Life? This particular Patient, and most long-term ventilated Patients with Tracheostomy, could go home after day 60 and they could be provided with a much better Quality of Life and/or Quality of-end-of-Life than it can ever be achieved in a Critical Care environment. Furthermore, especially is Families have constraints around visiting their loved ones, as was the case with this particular Patient, why not take a Patient home and have them surrounded by their loved ones?

Any other industry is creating real world solutions for their Customers, generally through innovation. The health Industry is extremely slow to embrace new models of care, that provide real and tangible benefits and opportunities for Patients, Families and Hospitals alike, especially if those models of care exist in other countries that have proven to be effective and Patients, their Families and Hospitals prefer to have long-term ventilated Patients with Tracheostomy in the Home, looked after by highly skilled Critical Care Nurses. Those long-term ventilated Patients with Tracheostomy and their Families would never in a Million years go back to Intensive Care if they can stay at home

Cleaning Your Tablecloths for Holiday Catering

Restaurant linens, though not frequently considered when dining out, are one of the foundational items that have the ability to imbue a place with the right feel and atmosphere. On the other hand, haphazard, dingy or soiled linens make even the most scrumptious meal seem sloppy and inadequate. A restaurant with a talented chef and reliably outstanding food immediately seems less appealing when dishes are served on dingy or stained linens. Tablecloths are the canvases on which artful food is served, and the presentation of the table impacts how the food is perceived. The same holds true for catering, in that the visual presentation is at least as important as the food itself - and perhaps even more persuasive, considering how people are programmed to interpret sensory data.

Artful Presentation Matters

As we all know through experience, first impressions are everything, especially when it comes to business. Our brains are wired to receive information about our environments continuously through every sense we have. The sensory stimuli that we take in at any given moment are rapidly categorized and translated through our individual experiences. This information works together to help us make judgments and decisions, categorize events and create memories. Comforting smells, pleasant temperature, crisp linens, delicious food and music all create an experience when dining out. When one piece of the puzzle is missing, it skews the entire perception of the event. A movie theater that smells old and musty, for example, can impact what patrons remember from the outing. That same phenomenon can occur anywhere and is something to keep in mind when in the business of selling an experience, which is exactly what modern consumers expect when dining out or using a catering service.

Like dining out, people hire caterers for many reasons: to save time, celebrate a special occasion, or just to relax and enjoy being waited on. But the key is that regardless of why they are choosing to do so, they are counting on the ability to create a certain feeling and atmosphere with the catering company. Having staff in crisp, clean uniforms, pristine linens and well-prepared food all contribute to this atmosphere.

When it comes to holiday catering, even more emphasis is placed on the visual. People enjoy the glitz and festivity that surrounds holidays and will want their catering company to pull out all the stops for their holiday party. This means including some tasteful and colorful decorations, as well as bright and impeccably cleaned tablecloths.

Tablecloths Help Create an Experience

Though smell has long been hailed as the most powerful sense we have in triggering memories, sight has also been proven to affect taste. In 2004, researchers at Oxford University revealed that there is a complex interplay involved between senses in the brain. This enables us to experience and understand the world in a unified way. These findings are particularly useful for those in the food and entertainment industries. We now frequently see business marketing that promotes this "selling an experience" approach. For restaurants and caterers alike, it is important to consider all the senses and how their business will be perceived by each facet of the consumer's perception.

Benefits of Professional Laundering

Using a professional laundering service is the most efficient way to get crisp, clean linens for your holiday parties. Professionals are trained to handle high volumes of tablecloths at a time and can even help to cut down on risk for infectious disease, such as the spreading of the common cold. Before and after each event, it's important to send linens out to be professionally laundered. Doing so not only ensures your tablecloths will be neatly pressed and ready in time for your event, but will also cut down on spreading colds and flu that are common in the winter months.

Professionals ensure tablecloths are properly washed, pressed, folded and looking fresh. They also sanitize, remove stains and unpleasant smells, and eliminate disease-causing germs. Taking great care of your linens is an integral part of creating a festive and elegant dining experience; the extra effort will not go unnoticed by your customers.

The Issues the Common Cold Creates in Hospitals

Cold and flu season, which typically ranges from October to May in the U.S., presents a challenging time for hospitals. Already full of sick and recovering patients, hospitals are the perfect breeding ground for viral rhinitis, aka "the common cold." Once the illness is contracted, it is highly contagious and easily transmitted through medical linens, commonly used areas of the hospital, and hospital equipment. In patients with compromised immune systems, the rhinovirus can cause serious secondary infections that may linger for weeks or months. It can also aggravate existing chronic health conditions, such as asthma, allergies, diabetes and heart disease.

Rhinovirus and How it Spreads

There are more than 200 different types of viruses that cause the common cold. Rhinoviruses are the most prevalent sources, causing up to 40 percent of colds. Coronaviruses are responsible for roughly 20 percent, and respiratory syncytial viruses (RSV) cause up to 10 percent of colds. All of these viruses cause infection of the upper respiratory tract that primarily affects the nose, throat and sinuses.

Viral rhinitis is frequently acquired through direct contact with infected droplets projected from the nose or mouth through sneezing and coughing. Hand-to-hand contact is another easy infection route, where virus particles are passed from one person's hand to another. From there, the virus can be transported through rubbing your eyes or scratching your nose.

The cold virus is largely just a painful nuisance for a healthy individual, with many people catching a few colds each year. They typically include nasal congestion, sore throat, sneezing and coughing. These symptoms can last for up to two weeks. While colds are unpleasant, they are typically treatable at home with some rest, increased fluids and over-the-counter medication for symptoms. But for a person with an already compromised immune system, a common cold can have disastrous health complications.

What Colds Can Do

Common colds, though basically harmless for people in good health, can be dangerous foundations for several serious infections in patients with suppressed immune systems. If someone is recovering from chemotherapy or major surgery, a cold can last much longer than normal. Aside from displaying more severe symptoms and lingering longer than usual, the rhinovirus in an already immuno-deficient person can cause acute ear infections, sinusitis and other secondary infections, such as bronchitis, strep throat and pneumonia.

For people with heart disease, cold complications can be especially dangerous. Pneumonia and other lung infections make the weakened heart work even harder. In these situations, it is difficult to take in oxygen efficiently. This creates another demand on the heart to pump oxygenated blood throughout the body.

How to Reduce Infection

Good hygiene, proper hand washing and frequent disinfecting of communal surfaces and equipment are helpful in the prevention of spreading colds. But another common culprit for spreading infection among hospital staff - as well as patients - is contaminated hospital linens. Washing bedding and towels in hot water with regular detergent is not enough to kill off many types of viruses. One of best ways to prevent common cold outbreaks is using a professional hospital laundry service. They are equipped to effectively sanitize and launder infected linens and adhere to strict guidelines in doing so. Using only EPA-registered laundry disinfectant and washing in water temperatures above 160°F are some of the precautions they take to prevent the spread of disease. These efforts, when coupled with thorough disinfecting of equipment and highly trafficked surfaces, greatly reduce germs that are prevalent in hospitals.

Selecting Dental Chairs

Dental chairs are some of the most important items in any dental office. The chairs are what make it possible for the dentists to perform every single day since they are designed to put patients in the best positions to make it possible for them to access and assess the mouth in the best angles needed. The dental chairs need to be as comfortable as possible if at all the dentist and the patient are to enjoy every minute spent in the dental office.The dental chairs are used from the diagnosis stage to the treatment stage and this means therefore that a dentist will need to invest wisely in a great chair or chairs within the dental office. When choosing the best dental chairs for your office, there are things which need to be checked to ensure that you are purchasing a chair that will serve all your dental needs.