“In Caucasians, the disease often appears suddenly, which usually indicates a more mild form of the disease that is of short duration. African-Americans and Puerto Ricans, on the other hand, tend to develop the more long-term and severe form of the disease.

In the United States, the lungs are often the most common site of initial symptoms for those who experience a gradual onset of their long-term disease. Lung symptoms are common in African-Americans, Puerto Ricans, and Scandinavians. Persistent dry cough, fatigue, and shortness of breath are the most common initial lung-related complaints.”.

Cleveland Clinic

• Age and sex. Sarcoidosis often occurs between the ages of 20 and 40. Women are slightly more likely to develop the disease. • Race. African-Americans have a higher incidence of sarcoidosis than do white Americans. Also, sarcoidosis may be more severe and may be more likely to recur and cause lung problems in African-Americans. • Family history. If someone in your family has had sarcoidosis, you are more likely to develop the disease yourself.

Inflammatory Disease- Sarcoidosis or Sarcoid is a inflammatory disease that consists of granuloma.

Wide Spread Disease- Disease is wide spread in multiple organs.

• The Sarcoidosis disease tends to come and go all of a sudden.
• Disease may progressively develop as a serious illness.
• Patient may experience several relapse throughout the life.

• Sarcoidosis or Sarcoid is a gradual progressive disease.
• Microscopic lumps called granulomas start to appear in the affected organs.¹
• In most of the cases, these granulomas tend to clear with or without treatments.
• There are few instances where granuloma grows in size and continues to be a part of the organ.
• Granuloma eventually ends up as fibrotic lump but may cause several complications.

Causes

Doctors don’t know the exact cause of sarcoidosis. Some people appear to have a genetic predisposition to develop the disease, which may be triggered by bacteria, viruses, dust or chemicals.

This triggers an overreaction of your immune system and immune cells begin to collect in a pattern of inflammation called granulomas. As granulomas build up in an organ, the function of that organ can be affected.

Risk factors

While anyone can develop sarcoidosis, factors that may increase your risk include:

• Age and sex. Sarcoidosis often occurs between the ages of 20 and 40. Women are slightly more likely to develop the disease.
• Race. African-Americans have a higher incidence of sarcoidosis than do white Americans. Also, sarcoidosis may be more severe and may be more likely to recur and cause lung problems in African-Americans.
• Family history. If someone in your family has had sarcoidosis, you’re more likely to develop the disease.

Complications

For most people, sarcoidosis resolves on its own with no lasting consequences. But sometimes it causes long-term problems.

• Lungs. Untreated pulmonary sarcoidosis can lead to permanent scarring in your lungs, making it difficult to breathe.
• Eyes. Inflammation can affect almost any part of your eye and can eventually cause blindness. Rarely, sarcoidosis also can cause cataracts and glaucoma.
• Kidneys. Sarcoidosis can affect how your body handles calcium, which can lead to kidney failure.
• Heart. Granulomas in your heart can cause abnormal heart rhythms and other heart problems. In rare instances, this may lead to death.
• Nervous system. A small number of people with sarcoidosis develop problems related to the central nervous system when granulomas form in the brain and spinal cord. Inflammation in the facial nerves, for example, can cause facial paralysis.

“Sarcoidosis is an inflammatory disease that can produce small clusters of cells called “granulomas” anywhere in or on the body, including internal organs and the skin. A multi-organ disease, sarcoidosis may affect a range of systems, including the nervous system, musculoskeletal system, lymph glands, lungs, skin, liver, spleen, eyes, heart, brain, and kidneys. In some cases inflamed granulomas may interfere with the functioning of an organ. The disease is not contagious.”.

Icahn School of Medicine at Mount Sinai

“Chest surgery at Mayo Clinic (also known as thoracic surgery) involves the organs of the chest, but extends to the esophagus (tube between mouth and stomach), the trachea (airway) and the chest wall (rib cage and breastbone).  From some chest traumas that happen a chest tube maybe needed.  A flexible chest tube is inserted into the air-filled space and may be attached to a one-way valve device that continuously removes air from the chest cavity until your lung is re-expanded and healed.  The chest tube has different functions as well.”

MAYO CLINIC

Thoracotomy versus Thoracostomy:

Thoracotomy is surgery that makes an incision to access the chest. It’s often done to remove part or all of a lung in people with lung cancer. Thoracostomy is a procedure that places a tube in the space between your lungs and chest wall (pleural space).

Thoracostomy – the procedure to put a chest tube in places.

Thoracostomy inserts a thin plastic tube into the space between the lungs and the chest wall. The doctor may attach the tube to a suction device to remove excess fluid or air. Or, the doctor may use it to deliver medication into the space to decrease the likelihood that fluid will accumulate. This is called pleurodesis.

Your doctor may use thoracostomy to treat pneumothorax, also known as collapsed lung.

Your doctor will tell you how to prepare if this is not an emergency, including any changes to your medication schedule. Tell them if there’s a possibility you are pregnant and discuss any recent illnesses, medical conditions, allergies, and medications you’re taking, including herbal supplements and aspirin. They may tell you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to your procedure. Leave jewelry at home and wear loose, comfortable clothing. You may most likely need to change into a gown for the procedure.

Know the medical difference in the ending of these 2 terminologies above:  ostomy or -stomy : surgically creating a hole (a new “mouth” or “stoma”, see List of -ostomies) -otomy or -tomy : surgical incision (see List of -otomies) -pexy : to fix or secure. -plasty : to modify or reshape (sometimes entails replacement with a prosthesis).

Chest Tube (s):

How a chest tube removes fluid, blood or air:

Fluid in the intrapleural space is affected by gravity and localizes in the lower portion of the lung cavity. Tubes placed in these positions drain blood and fluid. Frequently applying suction helps with this drainage.

Pneumothorax = Air in the lung through a hole

Hemothorax = Blood in the lung.

They are even used on animals:

Risk Factors getting a Chest Tube:

• Pain during insertion and after placement of chest tube: Although pain during insertion and mild discomfort after placement are common, your healthcare provider can help minimize these effects with pain medicines.
• Infection
• Improper placement
• Dislodged chest tube
• Collapsed lung after removal of chest tube
• Bleeding at the site of insertion

“You might say that the heart is the “engine of life, without one we could not survive.”.

The Franklin Institute (https://www.fi.edu/heart-engine-of-life)

“Sepsis arises when the body’s response to an infection injures its own tissues and organs. It may lead to shock, multi-organ failure, and death – especially if not recognized early and treated promptly. Sepsis is the final common pathway to death from most infectious diseases worldwide, including viral infections.   Sepsis is a global health crisis.  It affects between 47 and 50 million people every year, at least 11 million die – one death every 2.8 seconds.  Depending on country, mortality varies between 15 and more than 50 %.  Many surviving patients suffer from the consequences from the Sepsis.

Severe acute respiratory syndrome (SARS) is a rapidly spreading, potentially fatal infectious viral disease.  The viral disease first appeared in Southern China in November, 2002 and spread to more than 24 countries including North America.”.

John Hopkins Medicine (https://www.hopkinsmedicine.org)

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
  

   5.TREATMENT:

• 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).
  

SIRS –

SIRS with a suspected source of infection is termed sepsis. Confirmation of infection with positive cultures is therefore not mandatory, at least in the early stages. Sepsis with one or more end-organ failures is called severe sepsis, and hemodynamic instability despite intravascular volume repletion is called septic shock.  Together they represent a physiologic continuum with progressively worsening balance between pro and anti-inflammatory responses of the body.

The American College of Chest Physicians/Society of Critical Care Medicine-sponsored sepsis definitions consensus conference also identified the entity of multiple organ dysfunction syndrome (MODS) as the presence of altered organ function in acutely ill septic patients such that homeostasis is not maintainable without intervention.

Objectively, SIRS is defined by the satisfaction of any two of the criteria below:

• Body temperature over 38 or under 36 degrees Celsius. (100.4 Farenheit down to 96.8° Fahrenheit)
• Heart rate greater than 90 beats/minute
• Respiratory rate greater than 20 breaths/minute or partial pressure of CO2 less than 32 mmHg
• Leukocyte (white blood cell) count greater than 12000 or less than 4000 /microliters or over 10% immature forms or bands.

Treatment:

Treatment focuses on the underlying cause. Early care to treat for septic shock is critical in patients suspected of infection and hemodynamic instability.

Routine prophylaxis, including deep vein thrombosis (DVT) and stress ulcer prophylaxis, should be initiated when clinically indicated in severely ill bed-ridden patients, especially if they require mechanical ventilation. Long-term antibiotics, when clinically indicated, should be as narrow spectrum as possible to limit the potential for superinfection (suggested by a new fever, a change in the white blood cell [WBC] count, or clinical deterioration). Unnecessary vascular catheters and Foley catheters should be removed as soon as possible.

SIRS is a syndrome, not a disease. Treatment of SIRS should focus on possible inciting causes. As the causes of SIRS include a wide range of disorders (eg, acute myocardial infarction, community-acquired pneumonia, ^[9] pancreatitis), the appropriate interventions will likewise differ from patient to patient.

“A virus is an infectious microbe consisting of a segment of nucleic acid (either DNA or RNA) surrounded by a protein coat. A virus cannot replicate alone; instead, it must infect cells and use components of the host cell to make copies of itself. Often, a virus ends up killing the host cell in the process, causing damage to the host organism. Well-known examples of viruses causing human disease include AIDS, COVID-19, measles and smallpox. “.

NIH National Human Genome Research Institute (https://www.genome.gov/genetics-glossary/Virus)

“Sometimes when patients are admitted to the hospital, they can get infections. This is a hospital-acquired infection. In the case of either MRSA or VRE, this may mean that symptoms begin 72 hours after admission to the hospital.”

Cornwall Community Hospital (https://www.cornwallhospital.ca)