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He had no other risk factors for developing sepsis, yet he quickly went into full-blown sepsis.” If sepsis is suspected, blood tests can be used to evaluate a number of factors that are common with sepsis: • A high white blood cell count indicating infection. • A low red blood cell count (anemia). • Various chemicals in the blood that may be evidence of poor liver or kidney function caused by organ failure. • An abnormally high blood level of lactate, an acid that is produced when oxygen levels in the body drop. • Blood clots. “We also use blood tests to figure out what types of bacteria are growing in the body and which antibiotics are appropriate to treat the specific underlying infections,” Halimi says. Other tests might include urine analysis for urinary tract infections, mucus sample testing for respiratory infections or sampling of wound secretions in infected wounds. If the original site of infection is not obvious, the doctor may order diagnostic imaging tests such as X-rays, computerized tomography (CT) scans, ultrasound or magnetic resonance imaging (MRI). Early Treatment Is Key “In patients with suspected sepsis, we may start treatment right away with intravenous fluids to raise the patient’s blood pressure and broad-spectrum antibiotics that kill many types of bacteria,” says Dr. Halimi. “Timing is of upmost importance, and we generally have to initiate therapy as soon as possible, administering fluids and antibiotics within three hours.” After initial treatment in the ER, sepsis patients generally are admitted to the Intensive Care Unit (ICU) or to medical wards or for continued care. After learning the results of blood testing, the physician may switch the patient from a broad-spectrum antibiotic to one that is specifically effective against the particular bacteria causing the infection. If the patient’s blood pressure remains too low, even after receiving IV fluids, the doctor may order a vasopressor medication to constrict the blood vessels and help increase blood pressure. Other medications to treat sepsis patients might include corticosteroids to control inflammation, insulin to maintain stable blood sugar levels, and drugs that modify the immune system’s responses. Some patients with severe sepsis-related problems may require additional treatment such as a

ventilator to help them breathe or dialysis for kidney failure. Surgery may be needed to remove abscesses (collections of pus) or other local sites of infection. Patients also may require ongoing treatment for underlying conditions such as diabetes. Working to Reduce Sepsis Mortality Washington Hospital has taken an aggressive approach to reducing the number of deaths due to sepsis, focusing especially on efforts in the ER and ICU, developing protocols and instructing staff to recognize the signs of sepsis and treat it aggressively. “We have a standard protocol of screening for sepsis in every patient who is admitted to the hospital,” says Dr. Halimi. “That even includes patients who are admitted for a surgical procedure, whether or not they show any signs of infection.” The hospital also works in partnership with other organizations to promote better management of patients with severe sepsis. “Most recently, we just completed a study in collaboration with Highland Hospital to evaluate how we can teach paramedics to assess patients for sepsis while they are on the way to the ER,” Dr. Halimi says. “We want to train paramedics to begin treating patients who may have sepsis right away with fluids to stabilize their blood pressure and cooling measures to reduce fevers. We also want to establish a ‘code sepsis’ warning for paramedics to promptly alert the receiving hospital that the incoming patient may have sepsis.” Dr. Halimi says that not all people who think they might have early sepsis need to rush to the ER, however. “Most primary care physicians should be aware of the symptoms of sepsis, and they usually know their patients well, including their medications and any chronic conditions,” he says. “If you have any reason to suspect sepsis, you might want to call your primary care provider or advice nurse first before rushing to the hospital. It really is important to catch sepsis early, though. I tell patients that they know their own bodies better than anyone else. If you get a cough or cold, and it continues to get worse instead of better, see your doctor. And people with chronic conditions or other risk factors for sepsis need to be even more aware.” To register for the upcoming seminar at on sepsis at Washington Hospital on May 13, visit For more information about sepsis, visit the Sepsis Alliance Web site at


the skills and qualities they will need for college (four years from now) and life after college (10-60 years out)? The term that educators and policy makers use to define the concept of an education that is relevant into the future is “a 21st Century Education.” When our family started the high school application process last year, I started to hear this term for the first time. As a member of the business community, I had not been exposed to it. It was my hunch that this was an industry-specific term. To test this assumption, I asked my business colleagues what the term meant to them: most replied that they had never heard it before, nor had the educational professionals in other countries to whom I had posed the same question.

SUBMITTED BY LAUREL SKURKO March was an important month for educators and students across the country: this is the time when elementary- and high school decision letters come back to the students and families who had submitted their applications. Many learn which schools accepted them, and then, over the course of a one-week period, make a final decision about the school they/their children will be attending. What is on many people’s minds is “the future of our education.” We ask ourselves, “Will the school that these students attend provide them with

I decided to learn more about the concept in two ways: (1) by looking at online educational resources; and (2) by surveying business and education professionals across several industries and cultures to see what they thought what skills would be needed by those in the work force into the future. I found when looking at educational resources, the results were fairly straightforward: it seems that educators had supplemented the “3R’s” (Reading, Writing and Arithmetic) with three additional zones. These included the “4C’s” (Creativity, Collaboration, Communication and Critical thinking), along with other points that seemed logical to the uninitiated. These included “Life and career skills,” in addition to another category

called “Information, media and technology skills.” While this sounds comprehensive, one has to wonder if there may be shifts in priorities as we continue to travel through the 21st Century (we still have over 85 years to go). There will be inevitable changes in what we consider crucial to a 21st century education because of natural developments in the world around us. It is for this reason that I believe that monitoring the market for our educational system over time is essential. With this in mind, I took a simple, second approach. This method involved surveying people in various industries – those making decisions about how students are educated and who will be hired. I asked these decisionmakers how they defined a 21st

Century Education. Over the last couple of weeks, when, in the normal course of doing business, I ran into one of these individuals, I asked the following questions: “How do you define a ‘21st Century Education’”? “When you are hiring people to work with your teams, what skills and qualities are most relevant? What kind of training do you hope is available for students in schools in our community?” The first question, unless I had asked an educator, was met with a puzzled look. This is the reason I asked the question the second way. It opened up a wealth of impassioned responses. Here, I am sharing a small sampling of some of those ancontinued on page 33

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