Posted: 25/07/2024
Sepsis is a life-threatening reaction. It is not contagious and occurs when the immune system responds to infection or injury. Usually, the immune system works to attack the infection but, occasionally, it overreacts and starts damaging the body’s own tissue and organs, causing widespread inflammation and impairing blood flow. If not treated, this can spread and lead to tissue damage, organ failure, amputation and death.
Anyone can get sepsis, but it is more common in those who are vulnerable to infection, such as the very young or old. The main symptoms to look out for are fever, chills, confusion, light-headedness, mottled skin, a rash, urinating less, fast breathing and high heart rate.
Sepsis does not usually lead to limb loss, particularly if it is treated promptly, but on occasion it can. The main reason that sepsis can lead to amputation is that it causes the blood to clot, restricting blood flow. This means that oxygen and nutrients cannot get to the tissues in the extremities and they begin to die (usually starting in the fingers, hands, toes, feet, arms and legs).
The death of tissue caused by loss of blood supply is called gangrene. It presents by the skin going red, purple, or black, and by pain and swelling in the affected area. The gangrenous tissue must be removed to stop the infection spreading. Sometimes, just an area of tissue can be removed, but, in severe cases, the whole body part must be amputated.
Some sepsis survivors, therefore, lose one or more limbs due to the condition.
Sepsis can move very quickly through the body and can lead to organ failure and death. It is therefore a medical emergency and should be treated, usually with IV antibiotics, as swiftly as possible.
Sometimes, the condition is not recognised or treated fast enough by medical professionals, leading to a worse outcome than if it had been treated in a reasonable timeframe. Alternatively, incorrect or insufficient treatment might be provided. If some of or all the injury would have been avoided with the correct standard of care, a clinical negligence claim may be made.
The aim of a clinical negligence claim is to recover damages to compensate the injured person for their losses. The damages that can be recovered will vary depending on the circumstances of each claim. The general rule is that only losses caused by the failings in the medical care can be recovered. Some of the types of loss relevant to amputation claims may include:
These losses may be costs that have already been incurred, as well as recommended items for the future.
Undergoing an amputation is devastating and life-altering and can impact upon every aspect of a person’s life. The physical changes (such as pain, and reduced functionality, strength and muscle tone) and psychological symptoms (such as trauma, anxiety, depression and reduced self-esteem) lead to further multidirectional changes to the person’s life.
For example, a person living with poorly controlled pain can experience a negative impact upon their sleep, leading to fatigue. Someone who is chronically fatigued can then struggle to engage with rehabilitation and physical activity, causing difficulties completing aspects of daily living (such as eating, bathing and changing) and hobbies.
A person who has undergone amputation can suffer from decreased self-esteem and distorted body image, which can lead to lack of social engagement, isolation, and sexual impairment.
It is crucial for a patient’s case manager to understand the problems that can occur as a result of amputation and their impact upon not only the client, but also upon their friends, family and their vocational future. It is also crucial for them to understand how best to address these problems and provide support.
People living with limb-loss can experience a loss of independence owing to the physical, psychological, and social changes they face. Common support that case managers can facilitate for clients include: prosthetics, counselling, physiotherapy and pain management to address the physical and psychological symptoms. Case managers will subsequently monitor all treatment to ensure that it is clinically justified, appropriate, timely and engaging to the client to ensure that the best clinical outcomes are achieved. They will also ensure that all treatment recommendations are agreed by the instructing parties and that relevant funding is in place.
For some clients, a number of less obvious difficulties relating to amputation can have devastating effects on their life such as: difficulties driving, weight gain and lack of meaningful activity. Some of the support available for clients experiencing difficulties driving include: establishing taxi accounts, procurement of a blue badge, enrolment onto the Motability scheme, vehicle adaptations, driving lessons and psychotherapy for travel anxiety.
Case managers can support a client experiencing weight gain by facilitating personal training sessions, gym memberships, dietician/nutritionist support, exercise sessions (such as pilates) and GP consultations.
It is important to note that, although case managers can access private rehabilitation (providing funding approval), NHS intervention should always be considered when assisting amputees. Furthermore, collaboration of both NHS and private therapists and treatment providers is essential to ensure transparency of the client’s difficulties, goals, treatment pathways and potential barriers to rehabilitation.
Victoria Johnson, an associate in the clinical negligence team at Penningtons Manches Cooper, who specialises in sepsis claims, said: “Sepsis is treatable, but it can be frightening because it moves so quickly and the effects can be so severe if appropriate treatment is not provided in time. Make sure you know the signs to watch out for in adults and children and seek medical attention immediately.
Losing a limb for any reason is a life-changing event, the effect of which cannot be underestimated. It is not just the obvious physical challenges but the psychological, emotional effect of such an injury that many of our clients struggle with, as life feels like it will never be normal again.
It is encouraging to hear about the range of opportunities that exist to help people who have lost limbs start to regain their independence. I hope that there will be further advances in technology and that more support becomes available to a wider range of people in the future.”
This article was co-written by Victoria Davies, a case manager at Bush & Co.
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