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Time to Act: Severe sepsis - rapid diagnosis and treatment saves lives

Abscess

A collection of fluid within infected tissue that contains large numbers of white blood cells.

Adenitis

Inflammation and enlargement of lymph glands, which may be painful.

Central venous line

A fine tube passed into one of the great veins in the chest, enabling the measurement of pressure to inform whether or not the circulation is adequately filled with fluid; and to administer fluids in a more reliable way than peripheral intravenous lines.

Chemotherapy

The use of powerful drugs that are toxic to cells, usually to treat cancer.  Such drugs suppress the normal function of the bone marrow, leading to reduced resistance and impaired response to infection.  (See also Neutropenia.)

Early warning score

An index calculated from the observation of vital signs used in patient monitoring, to ensure consistency in planning necessary further action.

Fluid resuscitation

The administration of a substantial volume (typically one litre or more) of fluid intravenously to support blood circulation.

Haemodynamics

The function of the circulation determined clinically – particularly by consideration of heart rate, blood pressure, peripheral tissue perfusion, and central venous pressure.

Inflammation

A complex cascade of events the body makes to defend itself against infectious micro-organisms, other harmful substances, and injuries. 

Inflammatory markers

Blood tests that may indicate the degree of active inflammation in the body as a whole.  Those most commonly considered are the white blood cell count, the C-reactive protein level, and the erythrocyte sedimentation rate.These measures have to be considered in the overall clinical context.

Necrotising fasciitis

Fast-spreading bacterial infection causing tissue death.  It can only be treated by urgent and radical surgical removal of infected tissue.  (Sometimes known colloquially as the ‘flesh eating disease’.)

Neutropenia

A low level of white blood cells in the blood, leading to increased risk of infection and impaired response to it.  The usual cause is severe disease of the bone marrow, often caused by treatment for cancer.  Sepsis developing in the presence of neutropenia is described as ‘neutropenic sepsis’.

Palliative

Treatment given with the intent of easing symptoms, rather than extending life.

Perfusion

Blood circulation through the body systems, assessed clinically by interpretation of physiological observations, the warmth of the hands and feet, and by the rate at which colour returns to tissue after it is compressed.

Physiological observations and monitoring

A set of measurements of vital functions – temperature, pulse, blood pressure, respirations, oxygen saturation and level of consciousness – enabling assessment of the severity of illness.  Used to calculate the early warning score.

Pneumonia

A severe infection of the lungs, causing them (in part) to become solid with inflammatory fluid. 

Pus

The fluid present in an abscess (see Abscess).  It is always cloudy, is often green in colour because of the number of white blood cells present, and is sometimes foul-smelling.

Sepsis

The presence of infection, with evidence of abnormal physiological observations or blood-test results, indicating that the body is making a systemic inflammatory response to defend itself. 

Severe sepsis

The features of sepsis, but with additional clinical features such as low blood pressure, indicating impairment of the blood circulation; and/or abnormal blood-test results, indicating that vital bodily functions are beginning to fail (particularly the kidneys, liver, and the blood‑clotting function).  

Septic shock

When low blood pressure due to sepsis does not respond to intravenous fluid replacement. 

Source control

An intervention by surgery or the insertion of a drainage tube for localised severe infection such as an abscess or gangrene.

Sepsis care bundles

A group of interventions that, when implemented together, achieve better outcomes than if implemented singly, derived from the Surviving Sepsis Campaign international guidelines.

Track and trigger

A clinical system in which the early warning score is used to determine the level and urgency of medical review, or the involvement of other clinical teams.

Triage

A clinical process based on the presenting symptom or injury and the measurement of vital signs, used to determine the level of priority for necessary further action.

Vasopressors

Drugs that constrict small blood vessels, so increasing the resistance of the circulation and increasing blood pressure.