Translator: Lisa Rodriguez Reviewer: David DeRuwe
While I'm talking, about nine people in the U.S. will die from sepsis.
People of all ages, with or without other health problems, get sepsis.
Yet only two thirds of Americans have heard of it,
and only one third know the symptoms
despite the fact that it's twice as common and twice as deadly as stroke.
So what is it?
Our understanding of sepsis has changed throughout history,
including big changes in recent years.
It's currently defined as a dysregulated,
think out-of-control, immune system response to an infection.
Left untreated or in severe cases,
it can impact your body's ability to deliver blood,
and therefore oxygen, to your organs,
which can lead to tissue damage, organ failure, and death.
And survivors can have long-term negative effects.
Here's something else that many people don't know about sepsis.
It's a time-sensitive emergency.
That means the sooner you get treatment, the more likely you are to survive.
Heart attacks, strokes, and trauma
are time-sensitive emergencies that many of us already know about.
They're like motorcycles.
They get up to speed very quickly, and they can be stopped quickly
if you apply the brakes in time.
Sepsis is different.
It's a little bit more like a loaded train.
It can take a while to get rolling,
or it could be like a bullet train that starts really fast,
but once it's rolling at a high rate of speed,
it takes a really long time to stop.
So the sooner you start applying the brakes, the better.
Now, I want to share a story with you about Larry and Carol.
They're in their late sixties, they're active,
they mountain bike in the summer, they ski in the winter.
Larry's a little bit overweight with mildly high blood pressure
that he tries to manage by eating healthy and watching his weight.
His heart's strong from all that activity they do,
and they pay attention to their health.
They go to the doctor every year, and they get their flu shots,
but this year Larry got sick anyway.
So he had flu-like symptoms for a couple of days,
and on the third day, he woke up with a pain in his chest
that was worse
than what you would expect from just a cough.
And Carol was worried because he didn't look good,
and he seemed a lot sicker than the day before.
So they did what many of us would do, they decided to wait a little bit.
Around three o'clock that afternoon, they went to urgent care.
There, the doctors and nurses did their thing,
including taking labs for blood
and doing a chest x-ray.
And the doctor told Larry, "I'm sorry, you've got pneumonia.
I've written you a prescription for an antibiotic.
I want you to start taking it right away and drink lots of fluids,
and if you're not feeling better in a couple of days,
follow up with your family doctor or come back and sue us - see us."
(Laughter)
So Larry and Carol went home and did as they were told.
Larry napped through dinner.
At bedtime, he felt really bad,
but they felt reassured because they'd seen the doctor,
and they figured the antibiotics would start working soon.
So they went to bed.
In the middle of the night, he woke up sweating and with pain,
and Carol helped him with a couple of Tylenol,
managed to get back to sleep.
In the morning, Larry woke up even sicker and acting a little confused.
So Carol helped him into the car and, along the way,
Larry started moaning and acting - was really confused and out of it.
So Carol decided to go to the emergency room
instead of urgent care.
There, they diagnosed Larry with septic shock
and they took him to the intensive care unit.
Four days later, his kidneys failed,
and Carol had to make the difficult decision
to take him off life support.
And Larry became one of those nine Americans
that die every 18 minutes from sepsis.
Now, Larry and Carol aren't real people,
but you can read dozens of true stories like this,
including stories of healthy young adults and children.
Could Larry have been saved?
They went to the doctor when they realized something was wrong.
At the urgent care, the doctor may have done everything correctly.
Larry didn't meet severe sepsis or hospital admission criteria
when he was there.
At the hospital, the healthcare team recognized the problem immediately
and did all the right treatments in all the right timeframes.
But diagnosis of sepsis is hard because it's a response to any infection -
skin, urinary tract, viruses like the flu, post surgery -
and you can get sepsis
when you're in the hospital for something else.
So the symptoms of sepsis are mixed in
with symptoms of whatever else you have going on.
Early signs can be subtle,
and they may become more obvious over time.
But remember the train.
It could be too late.
Here you can see that if you end up in the hospital for sepsis,
your risk of dying is much higher than if you end up in the hospital
for other things
we tend to think of as being deadly.
And you can also see that your risk of dying goes up
as it takes longer for you to get treated after you come to the hospital.
Now, most of what we know
about how patients fare when they get sepsis
is based on data from patients after they come to the hospital.
But with sepsis and the infection that comes before it,
symptoms can be present for days or even weeks
before patients get treatment,
and if you're in the hospital when you get sepsis,
you could be getting sicker for many hours before anyone suspects sepsis.
How many lives could be saved if we could recognize sepsis earlier?
Could we get to a six-hour head start on treating sepsis?
Technology may have some promise.
Someday our smartwatch or an embedded microchip
may be able to track our vital signs and other important things,
and artificial intelligence will know when we're sick.
And maybe we'll get a text message,
"You're very sick, at higher risk of needing emergency treatment.
Click this link for an urgent video e-visit."
But what about people who won't have access to that technology?
Or the 8 million people in the world who will die from sepsis this year?
We can't wait.
I can't wait.
I propose that the way to beat sepsis now
is to empower the people who have the most to lose
from late recognition of sepsis: patients and their families.
I believe we can get to earlier diagnosis of sepsis
if we draw on the strengths of both doctors and patients.
Of course, doctors have the critical knowledge
of the broad range of problems a patient can be experiencing,
and the deep understanding of science behind diagnosis and treatment.
But patients have an important role too.
They bring in unique understanding of their own health,
including what their normal looks like and how their current illness
is the same or different from previous experiences of being sick.
They have another important strength
that's often overlooked and it sounds a little silly,
but they spend the most time with themselves.
What I mean is, patients and the people who spend time with them
are in the best position to gather data and keep watch.
Of course, we all watch over our families and friends now when they're sick,
but I'm afraid that many of us don't have the knowledge and skills to do it well,
or at least not well enough, to beat sepsis.
So what's the secret sauce?
I've hinted at it already - doctors need more and better data.
Unless we have those microchips,
patients may be the best, if not the only, people who can provide it.
So what kind of data is needed?
Well, of course, we need to know the symptoms.
And there's one symptom that stands out
as being a little bit better than some of the others
at differentiating "regular sick" from "scary or sepsis sick."
And that's whether or not whatever you've got going on
has impacted your brain or your nervous system -
changes in your ability to think, dizziness, vision problems.
And there's also the signs, those are the things we can measure,
like your heart rate, your blood pressure, your temperature.
And there's one sign that stands out as being better able to separate
"regular sick" from "scary or sepsis sick,"
and that's your breathing rate, how many breaths you take in a minute.
You can see it in the rise and fall of your chest or your stomach.
But it's not enough to just know the signs and symptoms
and expect them to make themselves
obviously known to us at just the right time.
Suspecting sepsis and other time-sensitive illnesses
relies on a couple of other key things.
First, is what you're experiencing new or unusual to you?
Is it the worst pain you've ever experienced here or here?
Is it the sickest you've ever been?
Is it a strange and scary new symptom,
or is it an unusual combination of symptoms?
You've got a cut that's red and swollen
and you're feeling really fatigued or nauseous?
Second, are you getting worse when you should be getting better?
Now, here's the problem with knowing if you're getting worse.
It can be hard for us to see change over time.
Remember I mentioned that breathing rate was an important sign.
So I'll show you a couple of breathing rates.
Here's one.
(Inhales)
(Exhales)
(Inhales)
(Exhales)
(Inhales)
(Exhales)
(Inhales)
(Exhales)
Okay, here's another one.
(Inhales)
(Exhales)
(Inhales)
(Exhales)
(Inhales)
(Exhales)
Now, maybe you could tell
that the first one was faster than the second,
but would you have known that it was worrisome fast
if you didn't have anything to compare it to?
I'm not suggesting
that we all run to the emergency room every time we're sick,
but there are times when you should follow your gut.
That bad feeling you have may well be that unusual symptom,
even if you can't quite put your finger on what it is.
And there are times
when our normal human biases can fail us.
For example, we may be noticing
the good signs and not seeing the bad ones
so that we can keep on believing what we've already decided
or what we want to believe,
for example, that we're not that sick and don't need to go to the doctor.
I believe the way to make the most of our human strengths,
the fact that we're there
and we can see, hear, feel, and smell things that computers can't yet,
and overcome our human limitations,
those biases,
and that we can't see small changes over time and we lose track of time,
is for patients and their families to take a page from health care practice -
and that's the systematic and objective measurement of data.
Not for every little scrape or cough,
but if something different is going on, or you're worried,
or you don't know if you should go to the doctor,
or even if you're in the hospital and you don't know if you should speak up,
grab your tools, measure your signs, your breathing rate, your heart rate,
temperature, blood pressure if you can.
Track those other things, your pain, confusion,
what's going in and coming out, or not coming out.
And do it repeatedly over time, so you can compare.
Every few hours, more frequently if things are looking bad.
Ask your doctor, "How long before I should be feeling better?
What exactly should I watch for to know if I'm getting worse?"
And know your normals - don't be afraid to say,
"This is not normal for me.
Is this a change in the wrong direction or even could it be sepsis?"
I want to share a different version of Larry and Carol's story.
In this one, when they woke up, and things were unusual
and they were worried, they decided to track their data.
They still went to the urgent care at three o'clock,
but they brought the information with them.
And this time the doctor still said,
"Larry, you've got pneumonia, written a prescription for an antibiotic.
I want you to drink lots of fluids."
And the doctors and nurses did the same things.
But he also said,
"I'm a little worried
about the way your blood pressure and your heart rate are looking.
I think it's just a response to the pneumonia and pain,
but just in case, I want you to keep on tracking,
and you've been doing such a good job at that,
why don't you watch your respiratory rate too?
The nurse will show you how.
And if your blood pressure gets any lower
or your heart rate or respiratory rate get any higher
than what we've been seeing already,
I want you to go to the emergency room.
Don't wait."
So Larry and Carol went home again and did what they were told again,
and Larry napped through dinner again,
but this time, armed with the information,
they made their way to the emergency room at nine o'clock that night,
instead of the next morning,
and the information they brought with them gave doctors a head start
on understanding how Larry had been getting worse over time.
Now, Larry wasn't as obviously sick in this version of the story
than in the first version where he came in the morning.
So it actually took the doctors a little bit longer
to get to that sepsis diagnosis,
but they started treatment eight hours sooner.
Now, because we know so little about early sepsis
before the signs become apparent,
I can't say if Larry survives in this version of the story,
but I know this:
if I was Carol, I wouldn't think twice about gathering that extra data
and maybe making an unnecessary trip to the emergency room.
I would choose this version of the story for my Larry.
There aren't enough doctors and nurses to place hourly watches
on every patient with a sore throat or an upset stomach,
but I can watch my family.
If we can all watch one or two people,
then I believe we can save many, many more lives
than if we restrict our focus on this problem
to behind the walls of the hospital
or to people who wear scrubs and white coats.
Our children are learning in schools how to keep themselves healthy,
how to respond to heart attacks and strokes.
With sepsis as common and as deadly as it is,
let's add it to our health education curriculums.
And many of us already track data for our health and fitness.
Let's create tools, technologies,
and education
so that patients and their advocates
can partner in gathering, sharing, and understanding data
about how sick they are when they do get sick.
Let's create a stronger partnership between health care workers and patients
to beat time-sensitive illnesses like sepsis.
Thank you.
(Applause)