HouseCallVOLUME V ISSUE 2VOLUME VII ISSUE 1

Primary Care Physicians Play Leading Role In Regions And U.S.s Healthcare SystemsAsk The Doctor I Awards And Recognition I Foundation Updatesinside

HouseCall26-YEAR-OLD PATIENT PRAISES THE LIFESAVING TREATMENT SHE RECEIVED FROM ST. CLAIRS DEDICATED CARE TEAM

SavingAlison

2 I HouseCall I Volume VII Issue 1

Michele Weatherly was at work when she receivedthe phone call that every parent dreads. Thecaller identified himself as a physician in the Intensive Care Unit (ICU) at St. Clair Hospital, and told her

that her 26-year-old daughter, Alison, had been admitted

through the Emergency Room with pneumonia. She had been

intubated and placed on a ventilator. Her condition, the doctor

explained that day last fall, was very serious and he

urged Michele and her husband, Reg, to come to the Hospital

immediately.

That was the beginning of a long ordeal for the Weatherly

family of Upper St. Clair. Alison, a University of Miami (Fla.)

senior majoring in anthropology, was a bright, healthy, viva-

cious young woman who had dreams of graduate school and

a career in forensics. Living in an apartment in Mt. Lebanon,

she had taken a semester off and was looking forward to

returning to school to finish the final four classes that would

lead to her degree. Michele and Reg, who are attorneys in

downtown Pittsburgh, had taken Alison out for dinner just a

few days earlier. Alison seemed fine then, except for a cold.

I kept getting sicker instead of getting better, Alison recalls.

I didnt go to the doctor because I thought it was just a bad cold.

But I developed a fever, and my breathing became difficult.

I asked a friend to take me to St. Clairs Emergency Room.

By the time I got there, I was very sick, in extreme pain, unable to

breathe and feverish. I learned later that the doctors intubated

me right away and put me on oxygen and a ventilator; they

sedated me, started antibiotics and admitted me to the ICU.

SavingAlison26-YEAR-OLD ALISON WEATHERLY WAS CONFRONTING THE MOST SERIOUS

HEALTH PROBLEM OF HER YOUNG LIFE. THATS WHEN HER TEAM

OF CAREGIVERS AT ST. CLAIR HOSPITAL WENT TO WORK.

LIFESAVING TREATMENT

ABOUT THE COVERMichele Weatherly reaches out to her daughter, Alison Weatherly, during a recent visit to the ICU to thank

the physicians and nurses there who cared for Alison during her hospitalization. Pictured with Michele

and Alison are, left to right, Greg Thompson, R.N., Kristen Cardimen, R.N. and Gregory J. Fino, M.D.

Continued on page 4

Volume VII Issue 1 I HouseCall I 3

Former ICU patient Alison Weatherly, left, and hermother, Michele Weatherly, share a laugh with St. ClairHospital ICU registered nurses, Greg Thompson, rear,and Mike Sembrat, during Alisons and Micheles recentvisit with some of the clinicians who cared for Alison during her battle to overcome severe sepsis.

4 I HouseCall I Volume VII Issue 1

Continued from page 3

LIFESAVING TREATMENT

A very serious diagnosisAs bad as things were for Alison at that point, they would quickly

become far, far worse. Alison had pneumococcal pneumonia, which had

developed into severe sepsis, a raging, whole-body complication of infection

that leads to multiple organ failure, shock, abnormal coagulation (the bodys

blood clotting process), and sometimes, to a condition known as ARDS

acute respiratory distress syndrome. ARDS results in respiratory failure,

with poor ventilation, perfusion and low oxygen levels throughout the

body. It is about as sick as a person can get.

Sepsis is a medical emergency, a life threatening condition

that begins with a localized infection such as pneumonia, a

urinary tract infection or a surgical wound infection. Sepsis can

happen to anyone, but those at highest risk are usually the elderly

and people who are immunosuppressed due to chemotherapy

or transplant medication. Those who are hospitalized are at risk,

too, as they often have incisions and breaks in the skin. Sepsis

has one of the highest mortality rates of any medical condition; it carries a

far greater risk than heart attack or stroke. It is a major cause of morbidity

and mortality in hospitals throughout the world. Sepsis mortality is as high

as 80 percent for elderly or immunocompromised patients; in general, the

mortality rate is 40 percent. Fully one-third of those who develop severe

sepsis with ARDS will die.

Sepsis is triggered when some of the pathogenic organisms usually

bacterial, but sometimes viral or fungal get into the bloodstream, which

carries the infection beyond the site of origin to various organs. The body

goes into shock, cells are not perfused with the oxygen they require, and

they die. Organ damage, and eventually organ failure, is the result. The

signs of early sepsis are subtle: changes in body temperature, above or

below normal range; tachycardia (an abnormally fast heart rate); abnormally

rapid breathing; and low blood pressure.

In patients with sepsis, their bodies respond to infection with a tremendous,

all-out counterattack that

wreaks physiologic havoc

throughout their

systems. Gregory J.

Fino, M.D., a pulmo-

nologist and Co-Director of Critical Care at St. Clair,

who played a primary role in managing Alisons care in

the ICU, says the bodys immune system mounts a systemic inflammatory

response that sets off a cascade of events which lead to organ failure and,

all too often, death. The medical term for this response to infection is SIRS

systemic inflammatory response syndrome. The body reacts so vigorously

to the invading microbes that it overshoots a bit, Dr. Fino explains. We can

treat the infection with appropriate antibiotics, but theres no way to stop

Sepsis is a severe medical emergency,

a life threatening condition that can

happen to anyone.

Posing for a group photo in the ICU at St. Clair Hospital are, left toright, Greg Thompson, R.N., Kristen Cardimen, R.N., Michele andAlison Weatherly, Gregory Fino, M.D., and Mike Sembrat, R.N.

Volume VII Issue 1 I HouseCall I 5

the bodys attack mode. It will carry on for a week

or so. Once we have the infection under control,

we more or less wait for the body to heal itself,

as we provide support to the patient and do every-

thing we can to optimize the outcome.

Severe sepsis is a diagnostic challenge, but

identification of those at risk, recognition of the

early signs, and the prompt initiation of diagnostic

testing and treatment is critically important to good

outcomes. Early recognition and treatment of sepsis

greatly improve chances for survival. (Please see

sidebar on detecting sepsis in patients, page 8.)

A team is assembledThe situation in the ICU was dynamic and dramatic.

Alison was extremely unstable, in critical condition,

with regular fluctuations in her vital signs and

oxygen saturation levels. In constant attendance

was St. Clairs team of critical care experts

doctors, nurses, respiratory therapists and other

clinicians who worked to save Alison with a

robust response that matched the ferocity of her

illness. The team included Pulmonologist Dr. Fino,

a 30-year veteran of the ICU, and his colleagues:

Patrick Reilly, M.D.; Andrew Perez, M.D.; Laurie

Kilkenny, M.D.; and Zachary Young, M.D., all

pulmonologists and critical care specialists.

Also involved in Alisons care: nocturnist critical

care physicians Yvonne R. Chan, M.D. and

Maxim V. Bocharov, M.D.

Alison was deathly ill, Dr. Fino recalls.

She had a common, community-acquired form

of pneumonia, with inflammation throughout

her lungs. We provided fluid resuscitation and

tailored her antibiotic therapy specifically to the

pneumococcus. She was put into a medically-

induced coma to help us to better manage her

ventilation and for her own comfort. Alisons

lungs collapsed, requiring the placement of

chest tubes to re-expand them. We performed

a tracheotomy. She had respiratory failure, liver

failure, severe slowing of her heart rate and

arrhythmias. We utilized prone therapy, which

can improve ventilation.

Prone therapy with a Rotaprone bed is an

innovative intervention for severely ill patients

in the ICU who cannot be adequately ventilated

with the usual approaches. Alisons pneumonia

was so extensive, Dr. Fino explains, that we

could not provide oxygen via the ventilator to

keep her oxygen levels adequate. She was receiving

100 percent oxygen what we breathe normally

in room air is 21 percent. We were giving her

maximum levels of extra pressure on expiration

to push oxygen through the lung to the blood-

stream. But it reached a point where we could

not oxygenate her.

With pneumonia and ARDS there is a severe

mismatch in the lungs of oxygen and blood so

oxygen is not transferred into the blood stream

effectively. The Rotaprone bed literally rotates the

patient from side to side and prone allowing a

better mixing of the oxygen and the blood. Using

this bed allowed us to deliver intervals of prone

therapy over extended periods of time to help

improve Alisons oxygenation.

Alison spent nine days in the Rotaprone bed,

Dr.