When a sliver turned septic, Wyoming Medical Center's Code Sep sprang into action
By Kristy Bleizeffer Sep 29, 2015
It started with a simple sliver. Kaye Phiriot pulled out the small piece of wood, just a few centimeters long and lodged in the base of her thumb. She washed her hands and returned to work at a Casper hardware store.
Just over 24 hours later, Phiriot was in the Wyoming Medical Center emergency room fighting for her life. She had a fever of a 103.9 and red lines extended from her thumb to her forearm.
“It was tiny piece of wood. I just pulled it out and threw it to the ground,” she said.
Phiriot had never heard of sepsis before it almost killed her. Sepsis isn’t caused by any particular bug, virus or bacterium but results when the body’s immune system goes into overdrive, attacking the body’s own organs.
Sepsis is a medical emergency. For those whose develop severe sepsis or go into sepsis shock, national mortality rates can be between 50 and 80 percent. At Wyoming Medical Center, the rate is 15 percent. For patients like Phiriot, who was going into multi-system organ failure, our nationally recognized Code Sep protocol can mean the difference between life and death.
WMC instituted its Code Sep program two years ago. It is designed to mobilize the full sepsis team while transferring sepsis patients from the ER to the ICU in 60 minutes or less. Since its implementation, we have cut mortality rates for patients with severe sepsis or who have gone into sepsis shock by 40 percent.
WATCH: K2TV's Krystal Story talked with Kaye Phiriot of Casper for this report.
“We’re really cutting edge with this program. A lot of hospitals are looking to see if this is something they can implement at their hospitals,” said Davina Drazick, coordinator for patient care excellence and a member of our Sepsis Team. Last year, she presented our Code Sep strategy at the National Database of Nursing Quality Indicators (NDNQI) conference in front of hospitals across the country.
“Since we started the program, we have gotten 97 percent of sepsis patients to the ICU in under 60 minutes. Those patients who weren’t immediately transferred were undergoing other needed treatments such as a CT-scan or surgery,” Drazick said.
Like other emergency medical codes in the hospital, Code Sep is called overhead house-wide when a patient is believed to be at risk for sepsis. This immediately activates the full inter-disciplinary team which includes ICU intensivists and nurses, ER physicians and staff, infectious disease specialists and quality-control nurses. Upon being alerted to Code Sep, the on-site intensivist responds to the Emergency Room to access the patient and prepares for transfer to the ICU where doctors and staff specialize in this kind of intensive treatment.
Phiriot’s case is a good example of how the protocol works.
The day after pulling out the small sliver, her thumb ached, but she figured that was expected. By the end of her shift, she noticed a red line extending from her thumb to her arm. She decided to have it looked at after going home to clean up. In her bath, she felt feverish. She went straight to Wyoming Medical Center.
ER staff and physicians initiated the Code Sep after recognizing the threat of sepsis: Phiriot’s fever had spiked to 103.9, she was confused and her blood pressure was dropping. Staff transferred her to the ICU while notifying the on-call infectious disease specialist, Mark Dowell, M.D., of Rocky Mountain Infectious Diseases.
“It was very clear that something was going wrong rapidly. When I came in, her thumb was turning white, but was purple at the base. The whole hand was swollen and tender,” Dowell said. “I knew it wasn’t a typical cellulitis – an infection at the top layers of the skin. I knew it was something deeper -- like flesh-eating strep."
Flesh-eating strep, or Necrotizing fasciitis, is a rare but sometimes serious bacterial skin infection that spreads quickly and attacks the body’s soft tissue. The bacteria can live on the skin and enter the body through even small cuts or punctures. Phiriot was on the way to losing her thumb, and worse, she was going into multi-system organ failure, Dowell said. He called plastic surgeon Richard Jaouen, M.D., and Phiriot went straight to surgery.
It’s important to note that most people will not develop sepsis from a sliver or small cut. Sepsis most often results from pneumonias and infections of the abdomen, kidneys or bloodstream and typically in people who already have compromised immune systems.
“You can get it as a normal healthy person, but more commonly, something’s wrong with your immune system,” Dowell said. “That can be cancer, that can be steroids. Anything that is playing with your immune system increases the risk.”
People need to pay attention to their bodies, especially if they’ve suffered a cut or poke and notice a quick change in their health or a change of color around the wound.
“Kaye did everything right,” Dowell said. “She looked at her hand, said ‘this isn’t right and this is getting worse. She came to the hospital at the perfect time.”
Phiriot has scars on her forearm and thumb where the surgeon went in to remove dead tissue and make sure it hadn’t spread further up her arm. Her hand sometimes feels numb, but she is learning to write with it again. She’s just thankful she came to Wyoming Medical Center when she did.
“We are very proud of our Code Sep protocol,” Dr. Dowell said. “We track our outcomes, diagnoses, ask ourselves if we ordered the right test and evaluate our antibiotic choices. We compare that to national standards.
“The collaboration between the emergency room physicians, infectious diseases doctors and ICU physicians has been great,” he continued. “We have great communication and great coordination of care. When you come in with life threatening infection, you want people to recognize it quickly and deal with it.”
Get to know sepsis
September is Sepsis Awareness Month. Any infection, no matter how minor, in any part of the body can cause sepsis. While anyone can become septic, it is more common in the very young, the very old and in people with underlying health conditions. While there is no single sign of sepsis, the Centers for Disease Control and Prevention recommends you seek medical help if someone exhibits two or more of the following symptoms:
S – Shivering, fever or very cold
E – Extreme pain or general discomfort
P – Pale or discolored skin
S – Sleepy, difficult to rouse, confused
I – “I feel like I might die.”
S – Shortness of breath
Seek medical help immediately if:
- A child younger than 2 months has a fever, appears lethargic, isn’t eating, exhibits a change in normal behavior or has an unusual rash.
- Someone has confusion, dizziness, fast heartbeat, fast breathing, fever, chills, rash or dizziness.
Dr. Mark Dowell is an infectious disease specialist with Wyoming Medical Center and Rocky Mountain Infectious Diseases (RMID), 1450 E. A St. He is the Natrona County health officer and is board certified in infectious disease and internal medicine. RMID offers a full-breadth of outpatient infectious disease care and is looking to expand its outreach clinics. It has three full-time physicians, a half-time physician and a full-time nurse practitioner. For more information, appointments or referrals, call RMID at (307) 234-8700.