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The situation was, frankly, a little hairy. The infant was grey and shut down, breathing rapidly but scarcely whimpering a protest at the needle.
Cannulation had failed, and our first attempt at intraosseous access had just dislodged. The emergency care consultant was there with me, both of us started to feel things could go either way. The patient’s mother was holding herself together with an obvious effort, pale but dry-eyed, stroking her child’s head.
Half an hour later, things were looking up. We finally had access and 20ml/kg of crystalloid were working their magic. The baby still didn’t look ready to star in a Pampers advert any time soon but her colour had improved and her blood pressure was finally creeping up. It was only then that I had a chance to speak properly to the mother, to explain what we had been doing, and why, and what we expected to happen next. I believed, I said, that her baby had sepsis.
And that was when she lost it. Previously impressively composed, her face crumpled in dismay and she burst into tears. I was startled – it took me a moment to realise which bit of what I had said had alarmed her. She had held it together through the oxygen mask, the intraosseous needle, the scalp cannula – but the ‘s’ word was a step too far.
That was my first encounter with the new public awareness of sepsis. Sixty years ago, I’m told, cancer occupied the same place in the collective imagination: an almost supernaturally horrific fate, to be whispered about in dark corners. Thirty years ago it was AIDS. I’m sure, at other times and in other places, there have been other illnesses which evoked that shudder, that hushed voice.
For now, however, it’s sepsis. As with cancer and AIDS, its fearsome reputation is not unfounded – it’s a serious, potentially life-threatening condition. Through an entirely well-intentioned campaign, we have been taught to look for sepsis in every patient, to suspect it even where the evidence is limited, and sometimes to treat it even at the expense of another equally dangerous but less well-publicised diagnosis. There are clearly some benefits to our heightened alertness but the public terror of sepsis now goes well beyond the rational. That young mother already knew her child was very ill, but the word ‘sepsis’ evoked an almost superstitious level of dread.
We all know words are important. A ‘chest infection’ conveys different associations from ‘pneumonia’, and a diagnosis of Hodgkin’s disease doesn’t necessarily tell patients they have cancer. ‘Sepsis’ should be a useful label for a cluster of symptoms that remind us to look promptly and carefully for infection, not a bogeyman to frighten medical students. Whatever went wrong?
By the Secret Doctor
Wasn’t it called an overwhelming or critical, life threatening infection?
Sepsis isn’t something new just rebranding of what we have been treating for years without defining the source of the infection.
The amount of times in the past year or so I have been expected to justify why little Johnny who is charging around the consulting room, hasn’t got sepsis, just because someone has said sepsis to the parent.
Someone saw fit to hijack our clinical system so that a simple code of URTI automatically opened a sepsis protocol.
No thought of the possibility that by the time one had got to the point of putting the entry in the diagnostics were already over and a 20 pointless questions scenario were pointless.
Sepsis overload is a real phenomenon. It is also an example of the dumbing down of medicine so that any practitioner who has no experience of diagnosing and managing the acutely sick can do it. Ignore the 5 years of diagnostic training an several years of postgrad training that all Drs (GPS and hospital) have completed. We are not paramedics or ANPs and politely indulging those who think we need taking back to basics every time there is one or other initiative is patronising.