Archive | May 2019


Bacteremia is the presence of bacteria within the bloodstream, but this condition does not always lead to SIRS or sepsis. Sepsis is the systemic response to infection and is defined as the presence of SIRS in addition to a documented or presumed infection. 

MAYO Clinic

#1 1 in 3 who die in a hospital have sepsis!!!!!   Community help us, increase your knowledge in Sepsis for your family/friends!!



What is sepsis/SIRS actually?


Sepsis is a potentially dangerous or life-threatening medical condition, found in association with a known or suspected infection (usually caused by but not limited to bacteria).

     1.What causes sepsis?

In sepsis the infection has spread from a local area of the body with spreading into a systemic infection, this means the infection is in the blood stream now.  So you have gone from a infection in one spot (local) now in another area of the body, the blood stream (now a systemic infection), that goes to every tissue of our body bringing the infection to effect anywhere in our body from 2 or several organs in the body to death if not treated.

Bacterial infections are the most common cause of sepsis. Sepsis can also be caused by fungal, parasitic, or viral infections. The source of the infection can be any of a number of places throughout the body. Common sites and types of infection that can lead to sepsis include:

  • The abdomen—An inflammation of the appendix (appendicitis), bowel problems, infection of the abdominal cavity (peritonitis), and gallbladder or liver infections.  If spreads the peritoneum (The serous membrane lining the cavity of the abdomen and covering the abdominal organs.)  Through the membrane the infection spreads to a abdominal organ or organs.
  • The central nervous system—Inflammation or infections of the brain or the spinal cord, easy to get into the bloodstream.
  • The lungs—Infections such as pneumonia, our lungs give our blood oxygen so easy for the infection to spread into our bloodstream.
  • The skin—Bacteria can enter skin through wounds or skin inflammations, or through the openings made with intravenous (IV) catheters (tubes inserted into the body to administer or drain fluids). Conditions such as cellulitis (inflammation of the skin’s connective tissue) can cause sepsis.
  • The urinary tract (kidneys or bladder)—Urinary tract infections are especially likely if the patient has a urinary catheter to drain urine.

    Sepsis can strike anyone, but their are those at particular risk.

Sepsis has to show signs and symptoms to fulfill at least two of the following criteria of a systemic inflammatory response syndrome (SIRS):

  • elevated heart rate (tachycardia) >90 beats per minute at rest, your heart is fighting this infection.
  • body temperature either high (>100.4 F or 38 C) usually the case at first or low (<96.8 F or 36 C), the body now
  • increased respiratory rate of >20 breaths per minute or a reduced PaCO2 (partial pressure of carbon dioxide in arterial blood level)
  • abnormal white blood cell count (>12,000 cells/µL or <4,000 cells/µL or >10% bands [an immature type of white blood cell])

     2.Who is at risk for sepsis?

  • People with weakened immune systems
  • Patients who are in the hospital
  • People with pre-existing infections or medical conditions
  • People with severe injuries, such as large burns or bullet wounds
  • People with a genetic tendency for sepsis
  • The very old or very young.

    3.What are the symptoms of sepsis?

  • Decreased urine output
  • Fast heart rate
  • Fever
  • Or the opposite Hypothermia (very low body temperature)
  • Shaking
  • Chills
  • Warm skin or a skin rash
  • Confusion or delirium
  • Hyperventilation (rapid breathing)A person may have sepsis if he or she has:

    4.How is sepsis diagnosed?

  • A high or low white blood cell count
  • A low platelet count
  • Acidosis (too much acid in the blood); in the hospital what is checked is lactic acid blood level.
  • A blood culture that is positive for bacteria
  • Abnormal kidney or liver functionm


  • Patients who meet the above criteria on symtoms have sepsis and are also termed septic.  In acute hospitals if 2 of these infections are present in the patient a “Septic Code” is called to get pt on antibiotics 2 usually that include Vancomycin, with IVFs started continuously, blood tests including bacterial culture x2, to the ICU where closely monitored, on telemetry.  Keep the pt continuously clean.
  • The most important intervention in sepsis is quick diagnosis and prompt treatment. Patients diagnosed with severe sepsis are usually placed in the intensive care unit (ICU) of the hospital for special treatment. The doctor will first try to identify the source and the type of infection, and then administer antibiotics to treat the infection. (Note: antibiotics are ineffective against infections caused by viruses; if anything what is used is antiviral medications.)
  • The doctor also administers IV fluids to prevent blood pressure from dropping too low. In some cases, vasopressor medications (which constrict blood vessels) are needed to achieve an adequate blood pressure. Some patients are given new drug therapies, such as activated protein C (APC). And finally, if organ failures occur, appropriate supportive care is provided (for example, dialysis for kidney failure, mechanical ventilation for respiratory failure, etc.).
  • Commonly what is used when initially sepsis is diagnosed is Vancomycin with other antibiotics like Imipenum, Cefepime, and others depending on what the blood culture results show as the microorganism.  Antibiotics with Sepsis and SIRS is caused by a bacterial infection (many times it is).



“Psoriasis is thought to be an immune system problem. Triggers include infections, stress, and cold.  Psoriasis treatments include steroid creams, occlusion, light therapy and oral medications, such as biologics

Mayo Clinic



Psoriasis is a common skin condition that speeds up the life cycle of skin cells. It causes cells to build up rapidly on the surface of the skin. The extra skin cells form scales and red patches that are itchy and sometimes painful.

Psoriasis is a chronic disease that often comes and goes. The main goal of treatment is to stop the skin cells from growing so quickly.

There is no cure for psoriasis, but you can manage symptoms. Lifestyle measures, such as moisturizing, quitting smoking and managing stress, may help.


Psoriasis signs and symptoms are different for everyone. Common signs and symptoms include:

  • Red patches of skin covered with thick, silvery scales
  • Small scaling spots (commonly seen in children)
  • Dry, cracked skin that may bleed
  • Itching, burning or soreness
  • Thickened, pitted or ridged nails
  • Swollen and stiff joints

Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas.

Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission.

There are several types of psoriasis. These include:

  • Plaque psoriasis. The most common form, plaque psoriasis causes dry, raised, red skin lesions (plaques) covered with silvery scales. The plaques might be itchy or painful and there may be few or many. They can occur anywhere on your body, including your genitals and the soft tissue inside your mouth.
  • Nail psoriasis. Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Psoriatic nails might loosen and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble.
  • Guttate psoriasis. This type primarily affects young adults and children. It’s usually triggered by a bacterial infection such as strep throat. It’s marked by small, water-drop-shaped, scaling lesions on your trunk, arms, legs and scalp.The lesions are covered by a fine scale and aren’t as thick as typical plaques are. You may have a single outbreak that goes away on its own, or you may have repeated episodes.
  • Inverse psoriasis. This mainly affects the skin in the armpits, in the groin, under the breasts and around the genitals. Inverse psoriasis causes smooth patches of red, inflamed skin that worsen with friction and sweating. Fungal infections may trigger this type of psoriasis.
  • Pustular psoriasis. This uncommon form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips.It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters may come and go frequently. Generalized pustular psoriasis can also cause fever, chills, severe itching and diarrhea.
  • Erythrodermic psoriasis. The least common type of psoriasis, erythrodermic psoriasis can cover your entire body with a red, peeling rash that can itch or burn intensely.
  • Psoriatic arthritis. In addition to inflamed, scaly skin, psoriatic arthritis causes swollen, painful joints that are typical of arthritis. Sometimes the joint symptoms are the first or only manifestation of psoriasis or at times only nail changes are seen. Symptoms range from mild to severe, and psoriatic arthritis can affect any joint. Although the disease usually isn’t as crippling as other forms of arthritis, it can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent deformity.

When to see a doctor

If you suspect that you may have psoriasis, see your doctor for an examination. Also, talk to your doctor if your psoriasis:

  • Causes you discomfort and pain
  • Makes performing routine tasks difficult
  • Causes you concern about the appearance of your skin
  • Leads to joint problems, such as pain, swelling or inability to perform daily tasks

Seek medical advice if your signs and symptoms worsen or don’t improve with treatment. You may need a different medication or a combination of treatments to manage the psoriasis.


The cause of psoriasis isn’t fully understood, but it’s thought to be related to an immune system problem with T cells and other white blood cells, called neutrophils, in your body.

T cells normally travel through the body to defend against foreign substances, such as viruses or bacteria.

But if you have psoriasis, the T cells attack healthy skin cells by mistake, as if to heal a wound or to fight an infection.

Overactive T cells also trigger increased production of healthy skin cells, more T cells and other white blood cells, especially neutrophils. These travel into the skin causing redness and sometimes pus in pustular lesions. Dilated blood vessels in psoriasis-affected areas create warmth and redness in the skin lesions.

The process becomes an ongoing cycle in which new skin cells move to the outermost layer of skin too quickly — in days rather than weeks. Skin cells build up in thick, scaly patches on the skin’s surface, continuing until treatment stops the cycle.

Just what causes T cells to malfunction in people with psoriasis isn’t entirely clear. Researchers believe both genetics and environmental factors play a role.

Psoriasis triggers

Psoriasis typically starts or worsens because of a trigger that you may be able to identify and avoid. Factors that may trigger psoriasis include:

  • Infections, such as strep throat or skin infections
  • Injury to the skin, such as a cut or scrape, a bug bite, or a severe sunburn
  • Stress
  • Smoking
  • Heavy alcohol consumption
  • Vitamin D deficiency
  • Certain medications — including lithium, which is prescribed for bipolar disorder, high blood pressure medications such as beta blockers, antimalarial drugs, and iodides

Risk factors

Anyone can develop psoriasis, but these factors can increase your risk of developing the disease:

  • Family history. This is one of the most significant risk factors. Having one parent with psoriasis increases your risk of getting the disease, and having two parents with psoriasis increases your risk even more.
  • Viral and bacterial infections. People with HIV are more likely to develop psoriasis than people with healthy immune systems are. Children and young adults with recurring infections, particularly strep throat, also may be at increased risk.
  • Stress. Because stress can impact your immune system, high stress levels may increase your risk of psoriasis.
  • Obesity. Excess weight increases the risk of psoriasis. Lesions (plaques) associated with all types of psoriasis often develop in skin creases and folds.
  • Smoking. Smoking tobacco not only increases your risk of psoriasis but also may increase the severity of the disease. Smoking may also play a role in the initial development of the disease.


If you have psoriasis, you’re at greater risk of developing certain diseases. These include:

  • Psoriatic arthritis. This complication of psoriasis can cause joint damage and a loss of function in some joints, which can be debilitating.
  • Eye conditions. Certain eye disorders — such as conjunctivitis, blepharitis and uveitis — are more common in people with psoriasis.
  • Obesity. People with psoriasis, especially those with more severe disease, are more likely to be obese. It’s not clear how these diseases are linked, however. The inflammation linked to obesity may play a role in the development of psoriasis. Or it may be that people with psoriasis are more likely to gain weight, possibly because they’re less active because of their psoriasis.
  • Type 2 diabetes. The risk of type 2 diabetes rises in people with psoriasis. The more severe the psoriasis, the greater the likelihood of type 2 diabetes.
  • High blood pressure. The odds of having high blood pressure are higher for people with psoriasis.
  • Cardiovascular disease. For people with psoriasis, the risk of cardiovascular disease is twice as high as it is for those without the disease. Psoriasis and some treatments also increase the risk of irregular heartbeat, stroke, high cholesterol and atherosclerosis.
  • Metabolic syndrome. This cluster of conditions — including high blood pressure, elevated insulin levels and abnormal cholesterol levels — increases your risk of heart disease.
  • Other autoimmune diseases. Celiac disease, sclerosis and the inflammatory bowel disease called Crohn’s disease are more likely to strike people with psoriasis.
  • Parkinson’s disease. This chronic neurological condition is more likely to occur in people with psoriasis.
  • Kidney disease. Moderate to severe psoriasis has been linked to a higher risk of kidney disease.
  • Emotional problems. Psoriasis can also affect your quality of life. Psoriasis is associated with low self-esteem and depression. You may also withdraw socially.


“High blood pressure (also called hypertension) is a serious illness that affects nearly 65 million adults in the United States. High blood pressure is often called a “silent killer” because many people have it but don’t know it.”

U.S. Food and Drug Administration

Part II High Blood Pressure Education Month – Factors in helping blood pressure from becoming high.

Part II blood pressure Reduction 2  blood pressure3

Factors in helping to reduce or decrease high blood pressure, also noted as hypertension are:


Stress is defined as feeling tense on the inside due to pressures from the outside. Most of us have many of these pressures, and some handle them better than others. Since stress makes the heart work harder, try to find ways to relieve the pressure you felt when stressed.

One way of coping with stress is to deal with your feelings. You may feel depressed, angry or anxious because you have high blood pressure. These feelings are normal. It may help to talk about how you feel with your family and friends. When you accept that you have high B/P, you can put your efforts into living a more productive, good life with dealing with the hypertension.

Many people find yoga, meditation and prescribed exercise helpful. Always check with your doctor before starting an exercise program to make sure you get clearance of what is safe for you by your primary doctor or cardiologist.

-Eat less SODIUM

Sodium is an important substance. It helps your body balance the level of fluid inside and outside of the cells. To keep up this balance, the body needs about 2000mg of sodium a day or less. Yet most of us eat 3000 to 6000mg of sodium each day.

Most people with high b/p are asked to eat less sodium. Sodium attracts water and makes the body hold fluid. To pump the added fluid the heart works harder. Also sodium in the body causes the arteries to vasocontrict increasing pressure in the vessels causing the pressure to rise.

Most people with high b/p are asked to eat less sodium at 2000mg or less a day and this is to prevent water retention and vasoconstriction in which both actions increase the blood pressure. Follow your doctor’s advice about your sodium intake.

Many prepared foods and spices are high in sodium. But, the most common source of sodium is table salt. Table salt is 40% sodium and 60% chloride. One teaspoon of table salt contains 2000mg of sodium.


-Season foods with fresh or dried herbs, vegetables, fruits or no-salt seasonings.

-Do not cook with salt or add salt to foods after they are on the table.

-Make your own breads, rolls, sauces, salad dressings, vegetable dishes and desserts when you can.

-Stay away from fast foods. They are almost all high in salt.

-Eat fresh, frozen or canned, unsalted vegetables. These have less sodium than most processed foods. Read the labels and if they don’t have a label DON’T EAT IT. Read the labels and eat the portioned size it says to for 1 portion with keeping a diary of what you ate with adding the sodium and when it reached 2000mg no more food that day with salt in it unless the doctor prescribes less.

-Buy water packed tuna and salmon. Break it up into a bowl of cold water, and let stand for 3 minutes. Rinse, drain and squeeze out water.

-Don’t buy convenience foods such as prepared or skillet dinners, deli foods, cold cuts, hot dogs, frozen entrees or canned soups. These have lots of salt. Be picky on what you eat.

-Again, read all labels for salt, sodium or sodium products (such as sodium benzoate, MSG). Ingredients are listed in the order of amount used. A low sodium label means 140mg of less per serving. Try to buy products labeled low sodium/serving. Do not eat products that have more sodium than this per serving.

-AHA states, “If you drink, limit your alcohol consumption to no more than two drinks per day for men and no more than one drink per day for women. A drink is one 12 oz. beer, 4 oz. of wine, 1.5 oz. of 80-proof spirits or 1 oz. of 100-proof spirits.

I’ve read that red wine is heart healthy — can I drink as much as I’d like?
Unfortunately, red wine as a miracle drink for heart heath is a myth. The linkage reported in many of these studies may be due to other lifestyle factors rather than alcohol. Like any other dietary or lifestyle choice, it’s a matter of moderation.

If you need help–
If cutting back on alcohol is hard for you to do on your own, ask your healthcare provider about getting help.”

The AHA also states,  “Lifestyle plays an important role in treating your high blood pressure. If you successfully control your blood pressure with a healthy lifestyle, you might avoid, delay or reduce the need for medication.

High blood pressure is a “silent killer”
You may not feel that anything is wrong, but high blood pressure could be quietly causing damage that can threaten your health. The best prevention is knowing your numbers and making changes that matter in order to prevent and manage high blood pressure. “.

MAYO CLINIC provides information as well about HTN and how to prevent it by:

-“When you eat out, order baked, broiled, steamed or pouched foods without breading or butter or sauces. Also ask that no salt be added. Go easy on the salad dressing. Most are high in salt.

What not to buy:

-Canned Vegetables, sauerkraut. Self rising flour and corn meal. Prepared mixes (waffle, pancake, muffin, cornbread, etc…)

-Dairy Products- like buttermilk (store-bought), canned milks unless diluted and used as regular milk).   Egg substitute limit to ½ cup/day. Eggnog (store bought) and salted butter or margarine do not buy.

-Soups: Boullon (all kinds), canned broth, dry soup mixes, canned soups.

-Meats and meat substitutes not to buy= Canned meats, canned fish, cured meats, all types of sausages, sandwich meats, peanut butter, salted nuts.

-Prepared mixes (pie, pudding, cake) or store bought pies, cakes, muffins.

-Cooking ingredients to use low sodium type or limit to 2 tbsp/day=

Catsup, chili sauce, barbeque sauce, mustard, salad dressing.

-Drinks to stay away from Athletic Drinks (such as Gatorade), canned tomato or vegetable juice (unless unsalted).”




“High blood pressure usually has no signs or symptoms. That’s why it is so dangerous. But it can be managed. Nearly half of the American population over age 20 has HBP, and many don’t even know it. Not treating high blood pressure is dangerous. HBP increases the risk of heart attack and stroke.”

American Heart Association

Part I High Blood Pressure Education Month! What is high b/p exactly is, factors we can and can’t control that effect your B/P!

High Blood Pressure – what is it?

High Blood Pressure or Hypertension affects 80 million Americans and nearly half of the people in the UK between the ages of 65 and 74, and a large percentage of those between the ages of 35 and 65. One of the problems associated with high blood pressure is that you will probably not even know you have it until you happen to have your blood pressure taken during a routine physical examination.

Upon diagnosis, you may wonder why you never saw it coming. Most people don’t. Only those with severe high blood pressure experience any warning signs at all.

These signs can include headaches, impaired vision, and black-outs.

What is blood pressure ?

It is the measurement of the force that blood applies to the walls of the arteries as it flows through them carrying oxygen and nutrients to the body’s vital organs and systems. Naturally, our blood is under pressure as it rushes through our arteries. Even those with blood pressure in the normal range will experience an increase in their blood pressure during rigorous physical activity or during times of stress. It only becomes a problem when the blood continues to run high. This condition of blood pressure is known as hypertension or high blood pressure and in 95% of the cases, the cause of it is never known. However, we do know the factors that set a person up to develop hypertension.

Factors influencing High Blood Pressure

They are as follows:






1-Obesity=Those with a body mass index of 30 or greater.

2-Drinking more than 2 to 4 alcoholic drinks a day.

3-Smoking                                                                                                                    4-High cholesterol


6-Ongoing Stress/Anxiety

7-Continuous use of excessive salt consumption

Possible causes of High Blood Pressure

Sometimes the cause of a person’s high blood pressure is determined, but this happens in only 5% of the cases. When a cause is found, the person is diagnosed with secondary high blood pressure [hypertension]. In most of these cases, the cause can be linked to an underlying illness such as kidney disease, adrenal gland disease, or narrowing of the aorta. Contraceptive pills, steroids, and some medications can also cause secondary high blood pressure [hypertension], though instances of this are not all that common.

High Blood Pressure and the important numbers

We hear the numbers, but do we really know what they mean? Since your blood pressure numbers can help you to understand your overall health status, it is important that you keep track of it. By knowing where your numbers are right now, you can head off such serious high blood pressure complications as angina, heart attacks, stroke, kidney damage, and many others that might surprise you – like eye problems and gangrene.

Medical professionals generally provide your blood pressure to you in terms of two numbers – a top one and a bottom one. For example, if your blood pressure is 120/80, they may say that you have a blood pressure of 120 over 80. Here is a definition for these numbers:

The top number this is your systolic blood pressure. It measures the force of blood in the arteries as your heart beats. The top number means the pressure is reading your heart at work.  That is why this number is always highier.

The bottom number this is your diastolic blood pressure. It is the pressure of your blood when the heart is relaxed in between the times when it is pumping. Means the pressure is reading your heart at rest.  That is why the number is always lowest.

Your blood pressure requires monitoring when you have a systolic blood pressure of 140 or over and/or a diastolic blood pressure of 90 or over. Those with diabetes must maintain a lower blood pressure that those who don’t have the condition. Diabetics should maintain a blood pressure of less than 130/80.

Monitors for measuring High Blood Pressure

It is wise to monitor your blood pressure at home in addition to having it taken at your doctor’s office. This will allow you to provide your doctor with readings that have been taken over time, providing a more in depth look at your personal health condition. This will help him or her to prescribe the right hypertensive medication and treatment for your specific condition.

The best blood pressure monitors are those that take your measurement from the upper arm. Those that provide readings from the wrist or finger are not as reliable. You’ll also want to make sure that the blood pressure monitor you are considering has been proven in clinical trials. Trusted name brands include those made by Omron, LifeSource, Mark of Fitness, Micro Life, and A and D Instruments. There are other brands available – the important thing is to do your research.



“Bones support your body and allow you to move. They protect your brain, heart, and other organs from injury.

Bone is a living, growing tissue. It is made mostly of two materials: collagen (KOL-uh-juhn), a protein that provides a soft framework, and calcium (KAL-see-uhm), a mineral that adds strength and hardness. This combination makes bone strong and flexible enough to hold up under stress.

Bone releases calcium and other minerals into the body when you need them for other uses.

Think of bones like a bank, you deposit and withdraw bone tissue.  You deposit in childhood and teenage years when the bones grow.  Than older bones withdraw causing bones to become larger, heavier, and denser.”

NIH National Institute of Arthritis and Musculoskeletal and Skin Disease