How does a septic system work. What are the signs of a failing septic system. Why is proper septic system maintenance important. How can homeowners properly care for their septic systems.

The Basics of Septic Systems

Septic systems are underground wastewater treatment structures commonly used in rural areas without centralized sewer systems. These systems play a crucial role in treating household wastewater from bathrooms, kitchen drains, and laundry facilities. By combining natural processes with proven technology, septic systems effectively manage wastewater, ensuring environmental safety and public health.

Components of a Typical Septic System

A standard septic system consists of two main components:

• Septic tank
• Drainfield (also known as a soil absorption field)

The septic tank is responsible for digesting organic matter and separating floatable materials (such as oils and grease) from solids in the wastewater. The drainfield, on the other hand, is where the liquid effluent from the septic tank is released into the soil for further treatment and dispersal.

How Does a Septic System Function?

Understanding the workings of a septic system is essential for homeowners who rely on this wastewater treatment method. The process involves several stages, each playing a crucial role in treating household waste.

The Journey of Wastewater

1. All wastewater exits the house through a main drainage pipe into the septic tank.
2. The septic tank, a buried water-tight container, holds the wastewater long enough for solids to settle at the bottom (forming sludge) and oil and grease to float to the top (forming scum).
3. The tank’s design, with compartments and a T-shaped outlet, prevents sludge and scum from leaving the tank and entering the drainfield.
4. The liquid wastewater (effluent) then flows from the tank into the drainfield.
5. In the drainfield, the effluent is discharged through pipes onto porous surfaces, allowing it to filter through the soil.
6. As the wastewater percolates through the soil, harmful bacteria, viruses, and nutrients are naturally removed.

This process ensures that the wastewater is treated effectively before it reaches groundwater sources, protecting both the environment and public health.

Identifying a Septic System on Your Property

For homeowners unsure about their wastewater treatment system, there are several indicators that can help determine if a property uses a septic system.

Tell-Tale Signs of a Septic System

• Use of well water
• Absence of a water meter on the incoming waterline
• No sewer charges on water bills or property tax statements
• Neighbors with septic systems

If these signs are present, it’s likely that the property utilizes a septic system for wastewater treatment.

Locating Your Septic System

Once you’ve determined that you have a septic system, finding its exact location is important for maintenance and potential repairs. Here are some methods to locate your septic system:

• Check your home’s “as built” drawing
• Look for lids and manhole covers in your yard
• Contact a septic system service provider for professional assistance

Recognizing Septic System Failures

Identifying septic system failures early can prevent costly repairs and potential health hazards. Contrary to popular belief, a foul odor isn’t always the first sign of a malfunctioning system.

Warning Signs of Septic System Failure

Homeowners should be vigilant and look out for the following indicators:

• Wastewater backing up into household drains
• Unusually lush, green grass over the drainfield area, especially during dry weather
• Pooling water or muddy soil around the septic system or in the basement
• Strong odors near the septic tank and drainfield

If any of these signs are observed, it’s crucial to contact a septic professional immediately to assess the situation and prevent further damage.

The Connection Between Sepsis and Severe COVID-19

While seemingly unrelated to septic systems, the term “septic” has significant implications in medical contexts, particularly in relation to severe COVID-19 cases.

Understanding Sepsis in COVID-19 Patients

According to Steven Simpson, MD, professor of pulmonary and critical care medicine at The University of Kansas in Kansas City and medical adviser for the Sepsis Alliance, seriously ill COVID-19 patients are technically afflicted with sepsis. But what exactly is sepsis in this context?

Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. In the case of COVID-19, the infection is caused by the SARS-CoV-2 virus, and the life-threatening organ dysfunction can affect multiple systems, including the lungs, brain, kidneys, heart, and liver.

The Impact of Sepsis

Sepsis is a significant concern in healthcare:

• It is the leading cause of death in U.S. hospitals
• The estimated annual cost for acute sepsis hospitalization and skilled nursing is $62 billion
• In severe COVID-19 cases, viral sepsis can lead to multi-organ failure and critical illness

Understanding the relationship between COVID-19 and sepsis highlights the severity of the disease and the importance of prompt, appropriate medical care for severely ill patients.

Maintaining a Healthy Septic System

Proper maintenance of septic systems is crucial for their longevity and effectiveness. Regular care can prevent costly repairs and protect the environment from contamination.

Essential Septic System Care Tips

• Have your septic system inspected every 3-5 years by a professional
• Pump your septic tank as recommended by your inspector (typically every 3-5 years)
• Avoid flushing non-biodegradable items or harsh chemicals down the drain
• Conserve water to prevent overloading the system
• Keep trees and shrubs away from the drainfield to prevent root intrusion
• Avoid driving or parking vehicles on the drainfield

By following these maintenance guidelines, homeowners can significantly extend the life of their septic systems and avoid potential health and environmental hazards.

Alternative Septic System Designs

While conventional septic systems are common, alternative designs exist to address specific site conditions or environmental concerns.

Types of Alternative Septic Systems

Some alternative septic system designs include:

• Aerobic Treatment Units (ATUs)
• Mound Systems
• Recirculating Sand Filters
• Constructed Wetlands
• Cluster Systems

These systems may use pumps, sand filters, or other media to treat wastewater more thoroughly before it’s released into the environment. Some are designed to evaporate wastewater or disinfect it prior to soil discharge.

Choosing the Right System

The choice of septic system depends on various factors:

• Soil conditions
• Site topography
• Lot size
• Proximity to sensitive water bodies
• Local regulations

Consulting with a local septic professional or health department can help determine the most suitable system for a particular property.

The Environmental Impact of Septic Systems

Septic systems play a crucial role in protecting the environment when properly maintained and operated. However, failing systems can have significant negative impacts on local ecosystems and public health.

Benefits of Well-Maintained Septic Systems

• Natural filtration of wastewater
• Groundwater recharge
• Reduced strain on municipal water treatment facilities
• Conservation of natural resources

Consequences of Failing Septic Systems

When septic systems fail, they can lead to:

• Contamination of surface water and groundwater
• Spread of waterborne diseases
• Algal blooms in nearby water bodies
• Degradation of aquatic ecosystems

Understanding the environmental implications of septic systems underscores the importance of proper maintenance and timely repairs.

In conclusion, septic systems are vital components of wastewater management in many rural and suburban areas. By understanding how these systems work, recognizing signs of failure, and implementing proper maintenance practices, homeowners can ensure the longevity of their septic systems while protecting public health and the environment. Regular inspections, responsible water use, and prompt attention to any issues are key to maintaining a healthy and effective septic system.

How Your Septic System Works

Septic systems are underground wastewater treatment structures, commonly used in rural areas without centralized sewer systems. They use a combination of nature and proven technology to treat wastewater from household plumbing produced by bathrooms, kitchen drains, and laundry.

A typical septic system consists of a septic tank and a drainfield, or soil absorption field.

The septic tank digests organic matter and separates floatable matter (e.g., oils and grease) and solids from the wastewater. Soil-based systems discharge the liquid (known as effluent) from the septic tank into a series of perforated pipes buried in a leach field, chambers, or other special units designed to slowly release the effluent into the soil.

Alternative systems use pumps or gravity to help septic tank effluent trickle through sand, organic matter (e.g., peat and sawdust), constructed wetlands, or other media to remove or neutralize pollutants like disease-causing pathogens, nitrogen, phosphorus, and other contaminants. Some alternative systems are designed to evaporate wastewater or disinfect it before it is discharged to the soil.

Specifically, this is how a typical conventional septic system works:

1. All water runs out of your house from one main drainage pipe into a septic tank.
2. The septic tank is a buried, water-tight container usually made of concrete, fiberglass, or polyethylene. Its job is to hold the wastewater long enough to allow solids to settle down to the bottom forming sludge, while the oil and grease floats to the top as scum.
   Compartments and a T-shaped outlet prevent the sludge and scum from leaving the tank and traveling into the drainfield area.
3. The liquid wastewater (effluent) then exits the tank into the drainfield.
4. The drainfield is a shallow, covered, excavation made in unsaturated soil. Pretreated wastewater is discharged through piping onto porous surfaces that allow wastewater to filter though the soil. The soil accepts, treats, and disperses wastewater as it percolates through the soil, ultimately discharging to groundwater.
   If the drainfield is overloaded with too much liquid, it can flood, causing sewage to flow to the ground surface or create backups in toilets and sinks.
5. Finally, the wastewater percolates into the soil, naturally removing harmful coliform bacteria, viruses and nutrients. Coliform bacteria is a group of bacteria predominantly inhabiting the intestines of humans or other warm-blooded animals. It is an indicator of human fecal contamination.

View an animated, interactive model of how a household septic system works created by the Guadalupe-Blanco River Authority.

Do you have a septic system?

You may already know you have a septic system. If you do not know, here are tell-tale signs that you probably do:

• You use well water.
• The waterline coming into your home does not have a meter.
• You show a “$0.00 Sewer Amount Charged” on your water bill or property tax bill.
• Your neighbors have a septic system.

How to find your septic system

Once you have determined that you have a septic system, you can find it by:

• Looking on your home’s “as built” drawing.
• Checking your yard for lids and manhole covers.
• Contacting a septic system service provider to help you locate it.

Failure symptoms: Mind the signs!

A foul odor is not always the first sign of a malfunctioning septic system. Call a septic professional if you notice any of the following:

• Wastewater backing up into household drains.
• Bright green, spongy grass on the drainfield, especially during dry weather.
• Pooling water or muddy soil around your septic system or in your basement.
• A strong odor around the septic tank and drainfield.

Expert: Severe COVID-19 Illness Is Viral Sepsis

Sepsis is a life-threatening immune response to infection that leads to organ dysfunction, which is what happens in seriously ill COVID-19 patients, expert says.

Seriously ill COVID-19 patients are technically afflicted with sepsis, a national sepsis expert says.

Sepsis is the leading cause of death in U. S. hospitals. Sepsis is a costly condition, with costs for acute sepsis hospitalization and skilled nursing estimated at $62 billion annually.

Seriously ill COVID-19 patients have viral sepsis, Steven Simpson, MD, professor of pulmonary and critical care medicine at The University of Kansas in Kansas City and medical adviser for the Sepsis Alliance, recently told HealthLeaders.

“Sepsis is life-threatening organ dysfunction due to a dysregulated host response to an infection. In COVID-19 sepsis, the infection is the virus, and the life-threatening organ dysfunction is all the organs that can dysfunction, including lungs, brain, kidneys, heart, and liver. These are all organs that are classically associated with sepsis. COVID-19 that causes organ dysfunction is viral sepsis,” he said.

Related: How 2 Health Systems Lowered Sepsis Mortality

Sepsis can be caused by bacterial, fungal, and viral infections, and sepsis linked to viral infections is relatively common, Simpson said.

“In addition to the novel coronavirus, there are multiple other viruses that are linked to sepsis. Every year, thousands of people die from influenza sepsis. If you are immunocompromised, there are several herpetic viruses that cause sepsis. For example, if you are undergoing chemotherapy, there are several different viruses that can cause sepsis. We see viral sepsis all the time,” he said.

COVID-19 sepsis is more deadly than most forms of bacterial sepsis, Simpson said. “One of the problems with this illness is that it is not like a bacterial sepsis; where if you intervene with appropriate antibiotics early in the course of a bacterial sepsis, you can definitely keep it from progressing. We don’t have that capability with COVID-19.”

COVID-19 sepsis has a high mortality rate, he said. “For COVID-19 patients who require ICU care, by definition, nearly all of them have sepsis. And we know the mortality rate for COVID-19 patients in ICUs is in the range of 30%–40%.”

Limited treatment options

COVID-19 sepsis is deadly because there are few available therapies beyond supportive care, Simpson said.

“So far, we have remdesivir, which can shorten the duration of illness but does not save lives as far as we can tell. We have dexamethasone, which is an immunosuppressant. Presumably, what dexamethasone is doing is calming the host response to the coronavirus infection, and that does seem to help save lives. And the FDA recently gave approval to bamlanivimab—a monoclonal antibody to the virus. Bamlanivimab is for people who have mild illness who are not hypoxemic—they do not need oxygen. It looks like this therapy might prevent the need for hospitalization,” he said.

Dexamethasone has shown the most promise in combatting COVID-19 sepsis, Simpson said. “Once a COVID-19 patient has developed sepsis, we know that bamlanivimab and remdesivir are not going to be particularly effective at that point. Dexamethasone has been shown to be useful in septic COVID-19 patients—particularly patients who have been placed on mechanical ventilation.”

At this point, illness prevention is the best strategy to address COVID-19 sepsis, he said.

“If you want to prevent sepsis from COVID-19, you must prevent COVID-19. Clinicians all understand the utility of wearing masks, washing hands, and distancing ourselves from one another when we can. We need our patients to understand that. This is a definite case where prevention is the key, and it is why we are exploding all over the nation with COVID-19 because many people will not follow these simple recommendations.”

Sepsis awareness

A recent Sepsis Alliance survey gauged awareness of sepsis in the United States. The survey collected data from more than 2,000 adult Americans.

The survey has several key findings.

• Although sepsis is common in severe cases of COVID-19, only 34% of survey respondents were aware that sepsis is a possible complication.
   
• 71% of survey respondents were aware of the term sepsis, which is a six percentage-point increase from the Sepsis Alliance’s 2019 survey.
   
• There are stark racial disparities in sepsis awareness. Only 49% of people who identified as black were aware of the term sepsis; 63% of people who identified as Hispanic were aware of the term; and 76% of people who identified as white were aware of the term.
   
• Only 15% of adults could identify the four common signs and symptoms of sepsis, and one-quarter did not know any of the symptoms. The four primary symptoms of sepsis are fever, infection, mental decline, and extreme illness.
   
• There are disparities in sepsis awareness based on income: 79% of people who make an annual income of $75,000 or more are aware of the term, but only 64% of people who make $50,000 or less are aware of the term.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.

Septic Shock in Dogs

Sepsis, an overwhelming infection in the body, results in severe inflammation. Untreated, it can turn to severe sepsis, which can cause multi-organ failure (e.g., acute kidney failure, acute respiratory distress syndrome, or liver failure). When severe sepsis overwhelms the body, it results in septic shock. Even with aggressive treatment, septic shock can be fatal in dogs and cats; reported mortality rates range from 20% to 68% in dogs.

One cause of septic shock could be an untreated, severe infection, such as from:

• Ruptured intestines (typically from intestinal cancer or a foreign body obstruction)
• Kidney infection (e.g., pyelonephritis)
• Uterine infection in intact females (e.g., pyometra)
• Prostatic infection in male dogs (e.g., prostatic abscess)
• Severely infected wound (e.g., abscess or bite wound)
• Pneumonia
• Bacterial infection in the vertebrae (e.g., diskospondylitis)
• Joint infection
• Bacterial infection on the heart valves (e.g., bacterial endocarditis)
• Blood infection
• Pancreatic infection (e.g., pancreatitis or pancreatic abscess)
• Ruptured organs (e.g., a ruptured stomach secondary to gastric dilatation volvulus, a ruptured bladder secondary to bladder stones, or a ruptured gall bladder secondary to gall bladder stones)

Symptoms of septic shock include:

• Not eating
• Vomiting
• Drooling
• An elevated heart rate
• Dark red gums
• Pale, pink gums
• Dehydration
• Panting
• Difficulty breathing
• Weakness or lethargy
• Abdominal pain
• Diarrhea
• Straining to urinate or defecate
• Collapse
• Excessive licking of the rear end
• A foul odor from the rear end
• Vaginal discharge
• Fever
• A distended abdomen
• Death, even with treatment

Diagnosing septic shock in dogs
To diagnose sepsis, your veterinarian will need to run certain tests, including the following:

• Complete blood count (looking at the white and red blood cells and platelets)
• Chemistry (looking at the kidney and liver function, protein, blood glucose, electrolytes)
• Urinalysis
• Urine culture
• Chest and abdominal x-rays
• Coagulation testing (including a PT, PTT, and platelet count)
• Abdominal ultrasound
• Fluid analysis if there is abnormal fluid in the abdomen or chest
• Catscan or MRI
• Ultrasound of the heart (e. g., echocardiogram)

Blood work findings consistent with sepsis include:

• A highly elevated or decreased white blood cell count
• A highly elevated (i.e., hyperglycemic) or decreased blood sugar (i.e., hypoglycemic)
• An elevated or decreased red blood cell count (from dehydration or anemia)
• Increased liver enzymes (e.g., total bilirubin)
• Increased kidney values
• Abnormal clotting due to a severe complication called disseminated intravascular coagulation (DIC)

Septic shock treatment
Treatment for sepsis depends on the underlying cause, but is aimed at removing the source of infection (which is typically done by surgery, if involving the abdomen) or symptomatic supportive care. Specific treatment to counter septic shock includes:

• Intravenous (IV) fluids
• IV colloid fluids (e.g., Hetastarch [to help increase the protein in the blood stream and blood pressure])
• IV antibiotics
• Anti-vomiting medication
• Pain medication
• Vasopressors to increase the blood pressure
• Nutritional support
• Dextrose (sugar) supplementation
• Blood work monitoring (specifically of the electrolytes, blood sugar, white and red blood cell count, and clotting)
• Possible plasma transfusions if DIC is present
• Surgery, if indicated

Prognosis of septic shock
Unfortunately, even with aggressive treatment, the prognosis is poor to grave once septic shock has set into the body. The best thing that an owner can do is to seek veterinary treatment immediately. The sooner a problem or infection is recognized, the sooner treatment can be started, hopefully mitigating the risk of sepsis.

If you have any questions or concerns, you should always visit or call your veterinarian — they are your best resource to ensure the health and well-being of your pets.

The link between coronavirus (COVID-19) and sepsis

Sepsis is a life-threatening condition that requires emergency care.

You may have noticed that we’ve been talking about sepsis a lot over the past year. Sepsis is a life-threatening emergency, and quick treatment can rely on people at home noticing something is wrong and acting on their instincts to get help. This means it’s important that Queenslanders know what sepsis is and what signs to look out for in themselves and others. It’s also important to know that our emergency departments are open, safe and ready to look after Queenslanders, especially in a life-threatening emergency like sepsis.

You might have also heard about sepsis in a different context this year, linked to coronavirus (COVID-19). This is because sepsis is one of the ways that COVID-19 can cause serious illness and death. Below, we’ve explained how COVID-19 can cause sepsis and what Queenslanders can do to protect themselves.

Why does COVID-19 cause sepsis?

Sepsis, which used to be known as septicaemia or blood poisoning, occurs when the body’s response to an infection causes damage to healthy tissues and organs. It’s not actually the infection causing the problem, but the immune system over-responding to the threat and attacking healthy parts of the body.

Sepsis can be caused by any type of infection – viral, fungal, or bacterial – but it most commonly occurs with bacterial infections of the lungs, urinary tract (bladder, urethra, kidneys), abdomen, skin and soft tissues. It can lead to tissue damage, multiple organ failure and death.

Some of the people around the world who have died from COVID-19, have died because they have had sepsis. Once the disease has made them sick, their body has tried to fight off the infection and overreacted, shutting down their organs and killing healthy tissue. Now, when people are in intensive care with COVID-19, their doctors and nurses are on high alert for sepsis developing and causing them to become even more unwell.

What can I do to prevent myself and my family from getting sepsis?

Not all cases of sepsis are preventable. One of the best things Queenslanders can do is to know the signs of sepsis, so if they think they or someone they are caring for might have sepsis, they can get emergency medical help.

Adults with sepsis might experience one or more of the following symptoms:

• Fast breathing
• Fast heartbeat
• Skin rash or clammy/sweaty skin
• Weakness or aching muscles
• Not passing much (or any) urine
• Feeling very hot or cold, chills or shivering
• Feeling confused, disoriented, or slurring your speech
• Feeling very unwell, extreme pain or the ‘worst ever’.

Adults with sepsis might express that they feel like they are dying or that they have never been so sick and are worried about their health.

Children with sepsis might experience one or more of the following symptoms:

• Fast breathing
• Convulsions or fits
• A rash that doesn’t fade when pressed
• Discoloured or blotchy skin, or skin that is very pale or bluish
• Not passing urine (or no wet nappies) for several hours
• Vomiting
• Not feeding or eating
• A high or very low temperature
• Sleeping, confused or irritable
• Pain or discomfort that doesn’t respond to ordinary pain relief like paracetamol.

If you think you or someone you are caring for might have sepsis, you need to go straight to the nearest emergency department and ask, ‘Could this be sepsis?’. During the COVID-19 pandemic, our hospitals are open, safe and ready to look after Queenslanders.

Preventing infections can stop sepsis

You can also prevent sepsis by protecting yourself against getting infections, because infections can sometimes cause sepsis. When it comes to COVID-19, the best thing you can do is follow guidelines to help stop yourself and others from catching the virus. You should:

• Wash your hands often and properly
• Try not to touch your face
• Stay at least 1.5 metres away from anyone who is sick, coughing or sneezing
• Stay at home when you’re sick
• Follow social distancing guidelines by keeping 1.5 metres away from others – think two big steps.

You can find more information about how you can help to stop the spread of COVID-19 on the Queensland Government COVID-19 webpage.

This year, it’s also really important that you get vaccinated against influenza. Like COVID-19, the flu can affect the lungs and lead to pneumonia and further bacterial infections, which are common causes of sepsis. That’s why it’s really important that this year, we try to make sure as few people as possible get sick with the flu or COVID-19, which also reduces the risk of getting sepsis.

You can find more information about getting an influenza vaccine this year here.

More information

What is sepsis?

Coronavirus (COVID-19)

When an everyday accident leads to sepsis – what we can learn from Sadie’s story

Sepsis: how trusting her instincts helped Mel save her baby daughter’s life

The decision that saved Michael’s life from sepsis

How sepsis turned Therese’s run-of-the-mill surgery into a life or death situation

The Sofa Score (qSOFA) and Treatments

Jeff: So as well all know, sepsis is bread and butter emergency medicine, but, what is sepsis?  It seems that every month or so we have a new guideline, bundle, definition, or whatever… I think it’s best to start with the basics –  At its core, sepsis is a dysregulated response to infection that can be life-threatening.

Nachi: Right and it’s the combined inflammatory with immunosuppressive features of sepsis that lead to the devastating organ dysfunction and even death. Optimal management of septic patients has been a source of intense research, stemming from the landmark study by Rivers in 2001. Jeremy, can you give us a little historical context there?

Jeremy: Rivers was a real pioneer.  He found a 16% mortality reduction with randomization to an early aggressive care bundle.  Amazing work.  That being said, many components of that bundle have since been disregarded.  For example, Manny Rivers would measure CVP in all of his patients, something we rarely do.

Nachi: Not to cut you off and steal your thunder there, but we’ll get to the most recent updates in management shortly. Let’s first talk definitions and terminology, and specifically, diagnosis, which is definitely a big elephant in the room. As Jeff mentioned a few minutes ago, diagnostic criteria have undergone so so so many changes.

Jeff: Yes it has! 1991 marked the first standardized definition.   Then in 2001, sepsis-2 was introduced.  In 2014, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine started a task force, and by 2016, updated definitions were out again! Sepsis-3!! A lot of this came after the realization that SIRS was just too broad and was overly sensitive and non-specific. Jeremy, why don’t you take us through Sepsis 3.

Jeremy: So just to back up a little and frame this:

Here’s the fundamental problem:  As we like to say, “there’s no troponin for sepsis.”  And if you look at our patients, we tend not to miss the hypotensive, tachycardic, febrile patient.  We know they’re septic.  But how do we find the ones who don’t look as sick?  Frequently elderly, possibly with normal-ish vitals and no fever.  Those can be a lot harder to spot, but they may indeed be septic.  Also, for research purposes we have to have a common definition, so Sepsis 3 came up with something called the SOFA score.

The problem with the SOFA score is that its difficult to perform in the ED.  It has parameters like bilirubin that often aren’t available when we want to screen out very sick patients.  Fortunately there is the abridged version qSOFA, which identifies non-ICU patients who are at high risk of inpatient mortality.

So here it is, and if you get one thing from this episode, this is it:

There are ONLY 3 criteria to the qSOFA.  3 Criteria. RR > 22; AMS; SBP <= 100. That’s it. If you have two of these criteria, you are up to 14 times more likely to die of sepsis during a hospital admission. That’s pretty profound; these patients are very sick.  This is meant to replace SIRS.  It also captures  a much sicker population than the patients included in the Medicare definition.

Jeff: So why do you think these parameters turn out to be so useful?

Jeremy:  Drilling down into these criteria you can see the pathophysiology at work. Obviously, SBP < 100 means sick.  Interestingly, an elevated RR also turns out to be prognostic, because you’re seeing the compensation for an underlying acidosis.  WHen you see a patient breathing quickly, it’s either from a primary respiratory problem or them trying to relieve an underlying acidosis. The caveat here is that you have to check it. At our hospital in southern Manhattan, patients tend to breathe around 16.  At our hospital in northern Manhattan they like to breath around 18. It’s probably because the air is thinner.  Seriously though, you have to actually measure RR for this to work. Temp is not in QSOFA but we should be checking that too. And I mean checking it by putting something that measures temperature inside the patient. We’ve looked at the forehead and tympanic thermometers and in real world conditions, they tend to underestimate by a degree or more. Think about that. A patient with a headache and a temperature of 99.5 is a very different patient than one with a temp of 100. 5.  Make sure you measure temperature.

Nachi: Very true and these two patients can definitely go down very different management pathways! Rounding out our discussion on sepsis-3. We should note that severe sepsis is now a term of the past under Sepsis-3. And sepsis-3 redefined septic shock as “hypotension not responsive to fluid resuscitation” with the added requirement of vasopressors to maintain a MAP greater than or equal to 65 and with a lactate > 2. So quite a few changes!

Jeff: And Jeremy, sticky topic coming up here. Centers for Medicare and Medicaid Services (or CMS) quality measures – They haven’t really caught on to and adapted to Sepsis-3 yet, have they?

Jeremy:  The CMS mandate is based on the presence of SIRS criteria. Sepsis 3 is based on SOFA.  This is definitely confusing.  Part of the challenge in discussing this topic is separating out the QI guidelines from what is actually relevant to patient care based on the latest evidence-based medicine.  

Nachi: That seems fair.  We’re really going to put you in an uncomfortable spot for a second and push you here Jeremy. Do you have any insight into why CMS isn’t interested in following the mountains of research that have led to sepsis-3? Is there a reason they are sticking to their current criteria?

Jeremy:  I think some of it is the slow pace of bureaucracy and the time that it takes to develop a consensus on management.  Even if we can agree on who is septic, it’s really hard, if not impossible to link the care to a pay-for-performance metric which is what CMS ultimately would like to see.  That’s not how Sepsis-3, or for that matter, SIRS, was designed to be used.  You’re trying to take a tool which was originally designed for research and mold them into a tool used for pay for performance.

Nachi: What a struggle. The CMS metrics are slightly different from the 2001 sepsis guidelines also. Take a look at Table 2 of the article for a quick comparison of sepsis-3, 2001 sepsis, and cms side-by-side. And for those on twitter, we’ll be sure to tweet this table out too for your review.

Jeff: With so many different scores and definitions, I think that adequately sets the stage for the challenge this month’s authors faced coming up with real evidenced based guidelines.

Nachi: Oh absolutely.  And to make matters worse – this is a HUGE problem. We’re talking up to 850,000 ED visits annually in the US, and 19 million cases worldwide. Compounding this, sepsis results in death in approximately 1 out of 4 cases. Not only is it lethal, it is also very costly — 17 billion dollars per year in the US alone!

Jeff: And don’t forget importantly the 30-day hospital readmission rate. Sepsis is coming in at a higher readmission rate and cost per admission than acute MI, CHF, COPD, and PNA.

Nachi: Let’s speak briefly on the etiology and pathophysiology of sepsis: we all know that sepsis is due to local infections that then become systemic. Previously, it was believed that the bacterial infection itself was the cause of the clinical syndrome of sepsis. However, we now know now that the syndrome of sepsis is due to the inflammatory and immunosuppressive mediators that were triggered by the infection. Normal immune regulatory safeguards fail and this leads to the syndrome. And interestingly, several studies have shown that critically ill septic patients experience reactivations of specific viruses that were previously limited to patients with severe immunosuppression.

Jeff: Definitely something to look out for in your critically ill septic patients.  We should talk  briefly about the most common inciting infections that lead to sepsis. In order, these are: pneumonia, intra-abdominal infections, and urinary tract infections. No surprises there!

Nachi: Yeah, that basically parallels my own experience, so that’s reassuring!  That takes us to our next potentially controversial topic – blood cultures.  Jeremy – we’re going to punt this one back to you

Jeremy: This is another interesting topic that has received plenty of attention.   CMS loves blood cultures.  It’s an easy metric to track.  That doesn’t mean they’re always helpful.  We looked at our patients with lactates between 2.1 and 4.0 which had “severe sepsis.”  These patients were normotensive though, In other words, the ones that aren’t that sick.  We found that blood cultures are useful about 20% of the time.  That’s not bad.  So what do we do? We draw cultures before pushing antibiotics.  Is that helpful? Sometimes yes, does it waste money?  Debatable.  Does it help us meet our metrics, yes.

Jeff: And I think that gets at the crux of the problem here: we don’t want to delay antibiotics on anybody, but we must balance this with the potential harm of further increasing the drug resistant bacterial population via sound antibiotic stewardship.   Remember also that there is a broad differential for sepsis, with several “sepsis mimics”. To name a few, we have PE, MI, CHF, acute pulmonary edema, DKA, thyroid storm, GI bleeds, drug intoxications, and withdrawal syndromes, just to name a few.  In case that wasn’t enough check out Table 3 of the article.

Nachi:  And we already mentioned the leading causes of sepsis, that’s pneumonia, intra abdominal infections, and uti’s. But remember the source can be anywhere. Be sure to also think of pyelonephritis, central line associated bloodstream infections, prosthetics, endocarditis, necrotizing fasciitis, and meningitis.

Jeff:  I don’t think we need to dwell on this much longer – basically the differential is huge.  Let’s move on to my favorite section – prehospital care.

Jeremy: 20 pages of evidenced based recommendations and your favorite is the prehospital section, what’s up with that?

Jeff: I’m an EMS fellow, what can I say… Anyway, on to my favorite section — prehospital care.   This is always a hot topic because the prehospital period is a special opportunity to get early interventions in for septic patients  as 40 – 70% of all severe sepsis hospitalizations arrive via EMS.

Nachi: And in one study taking place in a large metropolitan area, prehospital care time was over 45 minutes, and less than  37% arrived with IV access. Of course, these numbers would vary significantly based on where you practice.

Jeff: So get this — one study showed that out-of-hospital shock index and respiratory rate were highly predictive of ICU admission. So clearly early recognition and therapy may play a role here. Another study, however, showed knowledge gaps by advanced EMS providers in diagnosis and management of sepsis. And yet another study showed that only 18 to 21% of confirmed septic patients were suspected of having sepsis by EMS. Out of hospital fluids were started in only half of patients with severe sepsis. In essence, there is likely a strong role here for pre hospital protocols for identifying and treating sepsis.

Nachi: In terms of pre hospital treatments though, prehospital IV fluids haven’t been shown to improve mortality, but have been associated with shorter hospital stays. Prehospital sepsis protocols have been described, but in general more research is needed in this area.

Jeff: While prehospital care hasn’t yet been shown to improve the prognosis of septic patients, those presenting via EMS do have shorter delays to initiation of antibiotics, IV fluids, and early care bundles. EMS should focus primarily on stabilizing vital signs and providing efficient transport. If it’s possible to establish an IV and initiate fluids without delaying transport, EMS should do that as well.

Nachi: And of course, oxygen for the hypoxic patients! Moving on to history and physical for your presumed septic patient. Jeremy, what are the big hitting things here that you always ask and check for, and that you make sure your residents are doing?

Jeremy:  After ABC’s and glucose, AMS is really important, it’s in the QSOFA SCORE.  Unfortunately, this can be hard in many septic patients where they’re baseline mental status is less than perfect.  The other thing is to try and find the source.  Finding the source lets you make wise choices about therapy.

Jeff:  Great point about the mental status – so many of our older population have an altered baseline, but recognizing changes from that baseline is key.

Nachi:  Absolutely, with that in mind, let’s talk diagnostic studies, especially lactate.  Where I trained, basically everybody was getting a lactate, even tired looking residents seemed to be having their lactates checked, and trust me, they weren’t looking that good…

Jeremy:  Brace yourself: lactate is really important in septic patients.   That being said, not every cause of elevated lactate is sepsis.  There is this animal called Type B lactic acidosis can come from numerous drugs like albuterol. Just because you see elevated lactate doesn’t mean you can forget about the other causes.  That being said, we know that patients with sepsis do better when they clear lactate.

Jeff: Seems like the evidence is definitely in favor of serial lactate testing…

Jeremy: For sure.  At least until you have a reasonable trend towards improvement.  We know lactate clearers do better.  We’ve looked at our own lactate numbers.  Interestingly, the takeoff point for sepsis seems to be around 2.5.  Meaning that patients with altered vitals and lactates above 2.5 tend to do worse.  But, there is a broad ddx to elevated lactate.   What is true, though, is that lactate is a marker for badness.  If your patient’s lactate is rising, yours should be too.

Nachi: I bet I’m a “lactate clearer”. I may add “lactate clearer to my CV,” sounds impressive.  But I digress…  Next up we have Procalcitonin.   Since procalcitonin becomes elevated in those with bacterial infections, intuitively, this should be a valuable marker to assess in potentially septic patients.  Unfortunately procalcitonin lacks negative predictive value so most literature supports its use in diagnosing pulmonary infections and for antibiotic de-escalation.

Jeff: Good to know, I’ve seen it being used a lot more recently and wondered how evidence based this test was.

Jeremy:  Honestly, I don’t see Procalcitonin changing ED management at the moment.  If you’re waiting for procalcitonin to start antibiotics or fluids, you’re waiting too long. 

Nachi: Moving on, let’s talk imaging.  Based on current studies, the authors recommend focused imaging only.  In addition, they also note that our good friend, the point of care ultrasound, likely plays a role, as in one study, POCUS demonstrated a 25% improvement in sensitivity from clinical impression alone.

Jeremy:  I think there are two ways POCUS comes in.  One, lung ultrasound can be really useful to find that occult pneumonia or differentiating pneumonia from CHF.   Two, your ultrasound is your best tool for assessing volume status.  I try to look at the IVC of all my septic patients and echo them when possible.

Nachi: Right.  So now we’ve examined, drawn labs and cultures, checked a lactate, may be obtained imaging… next up we should probably start treating the patient. Whether you like it or not, we have to discuss CMS.

Jeremy: Just to clarify before we start.  CMS defines “severe sepsis” as SIRS + infection with a lactate of 2.1-4.0. Septic shock is SIRS + infection with hypotension or a lactate > 4.0. That’s where we’re at.

Jeff:  Good point.  Back to treatment: within the first 3 hours, for any patient with sepsis and septic shock, you must measure a lactate, obtain 2 sets of blood cultures, administer antibiotics, and give an isotonic fluid challenge with 30 cc/kg to patients with hypotension or a lactate greater than 4.    Then, within the first 6 hours, you must apply vasopressors to achieve a MAP of at least 65, re-assess volume status and perfusion, and remeasure a lactate.

Nachi: This begs the question – are these recommendations evidenced based? Jeremy….

Jeremy: I’m so glad you asked that . Let’s start with fluids. Patient’s need adequate fluid resuscitation.  Interestingly there are 3 large RCT’s, PROMISE, PROCESS and ARISE,  that compared a Rivers type bundle to usual care.  Surprisingly, they showed no difference.  But when your drill down into these 3 trials, you see that “the usual care,” now generally includes at least 2 liters of fluid.

Jeff: Ok, so it seems that there is some pretty good data to support a rapid fluid challenge of at least 30 cc/kg.  But how do we determine who needs more fluids and how much more they need.  There must be an endpoint to all of this?

Jeremy: Another million dollar question. 30cc/kg is probably a good place to start.  How much is too much?  I think we need to be smart about our fluids.  Some patients will need less and some will need much more.  So, I remind my resident’s to be smart about fluids.  Sono an IVC, trend a lactate, follow a urine output, do a passive leg raise, even check JVP.  I mean just because you haven’t seen a unicorn doesns’t mean they’re not real.  Do something to monitor volume status.

Nachi: Very important. Put your ultrasound skills to work here. They’ll only improve as you practice more.  Jeff, let’s get started on the ever important topic of antibiotics.

Jeff: Sounds good.  Current guidelines recommend that broad spectrum antibiotics be administered within the first hour of presentation for those with sepsis or septic shock, ideally with blood cultures being drawn beforehand. In one study, every hour of delayed abx administration was associated with an 8% increase in mortality.   Since this 2006 study, other studies have had mixed results – with studies showing increased odds of death with delays in abx administration and others showing only a benefit in those with septic shock with or without hypotension with no benefit to those without shock.

Nachi:  In terms of antibiotic coverage – you need to consider the site of infection, local resistance patterns, the presence of immunosuppression, and the patient’s age and comorbidities.  Table 5 of the article is very thorough and should be kept as a quick reference. Jeremy do you have any specific recommendations for our listeners on how we should approach antibiotic usage in the septic patient?

Jeremy: I like to think about antibiotics a little more simply than referencing a table.  I ask a couple questions.  Does my patient need MRSA coverage ?  Does my patient need Pseudomonal coverage?  If the answer is no and no, then narrow your coverage.   You don’t necessarily have to use a bunch of Vanco, or a big gun antipseudomonal like Pip/tazo.  Also, have a look at your local antibiogram.  I can’t tell you how many times this changes prescribing habits for even things like simple UTIs.  I’m going to stray into some controversial territory here. The benefits of sepsis protocols are measured one patient at a time, but the harms are only measured in the aggregate.  What does that mean?  CMS metrics have caused us to  use to use more broad spectrum antibiotics.  As a result, we’re seeing more resistance.  My resident’s tell me to make it easy, give em VZ (that’s vanco/zosyn) and it kills me.   Every time you put a Z-pack into the world a pneumococcus gets it’s wings. So think more about your antibiotics, and know your local biograms.

Jeff: That’s a great way to think about it, I fear I’ve given a lot of pneumococci wings during my training…  Next we’re on to vasopressors.  The data is pretty clear on this one – norepinephrine is the recommended first line vasopressor for septic shock.   In numerous trials comparing Norepi to dopamine, NE was far superior, with dopamine increasing arrhythmias in one trial and associated with an increased risk of death as compared to NE in another trial.

Jeremy:  So here’s a question I get all the time: How can I give Norepi without a central line.  Let’s use Dopamine, its safe peripherally.  Ok, so follow that through.  We’re going to give a drug to increase blood pressure by constricting blood vessels, but don’t worry, it’s safe peripherally.  What does that mean?  It means it doesn’t work!!  It doesn’t give much blood pressaure.  Dopamine is a lousy pressor.  It causes a lot of tachycardia, which is not what you want in failing septic hearts.  So what do we do if we don’t have a central line?   We start norepi peripherally into a large bore IV for the time it takes us to get a central line.  That’s where the evidence is.  There’s a mortality benefit to NE over dopaine in septic shock.

Jeff:  Right, this month’s authors note peripheral pressors may be safe for brief periods in settings with close monitoring.   While this is commonplace in some hospitals, others haven’t yet jumped on that bandwagon. I think it’s important to mention that this is becoming more and more commonplace, even in the prehospital realm.  With the service I fly for, we routinely start peripheral vasopressors without hesitation.  But this isn’t limited to the air.  Many ground 911 services have also adopted peripheral vasopressors in a variety of settings.

Nachi: I’m sure there are many trials to come in the future documenting their safety profile, but moving on to the next pressor to discuss… vasopressin. This should be your second line vasopressor for septic shock.  In the VASST trial, low-dose vasopressin was found to be noninferior to NE.  In other trials, vasopressin also appeared to show a potential benefit in those with AKI and sepsis, although the subsequent VANISH trial (perhaps the best name for a clinical trial so far) failed to demonstrate a benefit to vasopressin titration with regard to renal outcomes in septic shock. Vasopressin has also been shown to reduce NE dosing when administered at a fixed dose of 0.03-0.04 units/min.

Jeff: Next we have epinephrine.  In one study epinephrine and NE were equivalent in achieving MAP goals in ICU patients with shock, however several of those receiving epi developed marked tachycardia, lactic acidosis, or an increased insulin requirement.  The increasing lactic acidosis could confound the trending of lactates, so in those requiring inotropy in addition to some peripheral squeeze – the authors recommend adding dobutamine to norepinephrine instead of starting epinephrine. Although, keep in mind, this can lead to some hypotension so remember to start at low doses.

Nachi: Phenylephrine, a pure alpha adrenergic agent, is next and should be considered neither first nor second line, but it may have a role as a push dose agent while preparing other vasoactive agents. 

Jeff: And lastly, we have angiotensin 2.   One recent 2017 study examining the role of angiotensin 2 in those with septic shock already on 0.2 mcg/kg/min of NE found that those receiving AT2 had significant improvements in MAPs as well as cardiovascular SOFA score at 48h with no difference in mortality.  Unfortunately, these benefits do not come without risk as AT2 may increase risk of arterial and venous thrombosis and potentially thromboembolism.  Clearly, one study isn’t enough to change practice, but it’s certainly food for thought.

Nachi: So that wraps up vasopressors. Jeremy, we’re on to corticosteroids — another hotly debated topic. When do you give steroids in sepsis?

Jeremy:  Hmmm steroids, this is an age old question.  No study has clearly supported the blanket use of steroids in septic shock. Several like CORTICUS and ADRENAL showed no difference.  I will use hydrocortisone for pressor refractory shock. Meaning, you’ve tried everything else, so you might as well try.   Also, I do tend to avoid Etomidate, given the possibility of adrenal suppression and that there are several other induction agents, notably Ketamine  that don’t have this problem. 

Jeff: Those trials are certainly important, thanks for bringing them up – Especially with all the FOAM content out there, it’s incredibly important to look back at the data to understand where certain recommendations are coming from.   Anyway… one quick note on blood transfusions before we move on to special populations – Although part of the original early goal directed therapy, thanks to data from the TRISS trial which showed no difference in outcomes with a transfusion goal of 7 vs 9, transfusions are reserved for those with a hbg of less than 7.

Jeremy:  One population we should make sure to mention and be careful with is end stage liver disease.  In the ER, we tend to miss SBP alot.  Mostly because these patients have lots of reasons to be sick and they already have elevated lactate because of their deceased clearance.   My practice is to give a dose of Ceftriaxone and sent a diagnostic tap to patients who are sick and have ascites. 

Nachi: Alright Jeremy, let’s talk controversies in sepsis. We’re giving you all the big questions this month!

Jeremy:  We’ve already talked about fluids and how much to give.  Just a reminder that a history of CHF doesn’t preclude proper fluid resuscitation.  I think broad spectrum antibiotics for relatively well patients is a big controversy.  Our national rates of antibiotic resistance are terrible, and yet we’re using more antibiotics all the time.  There are very few if any antibiotics coming down the pharma pipeline and we’re going to have to face the music eventually.  Finally, we need national metrics that mirror clinical evidnece.  Protocols should be a tool and not a crutch.  You know what’s best for the patient in front of you, so don’t let metrics or protocols make you do things you think are not in your patient’s best interest.  

Nachi: So how do you escape the hospital protocols and CMS and do what’s best for your patient without “getting in trouble”?

Jeremy: Here’s how I deal with it as the one who reads and QI’s all of our sepsis charts. I tell my colleagues to do what’s right, and if you need to deviate from the protocol tell me why.  As long as you can explain your decision, I’ll support it.  Explaining your thinking is good clinical practice and is good medico-legal practice. CMS has been unable to link these metric  to payment, simply because no hospital can meet them with any regularity.  It’s important that we advocate for our patients or nothing will change. Make them respect you for the highly educated professional that you are, and your patients will ultimately benefit.

Jeff: Preach!! And before we close out with disposition, there are a few new therapies and trials on the horizon to keep a lookout for. The RACE trail examined the role of L-carinitine.  The VICTAS trial is looking at vitamin C, thiamine, and steroids in sepsis.  The CLOVERS trial is looking at early vasopressors vs a crystalloid liberal strategy.  And lastly, IL-7 is also being investigated.  All really cool stuff that could change how we manage sepsis in the future..

Nachi  A few quick notes on disposition before we close this episode out.  Certainly not all patients meeting SIRS require admission, but many do.  Those with qSOFA of 2 or higher represent a sick population and an ICU admission should be considered.   Even for those with a qSOFA of 1 but a lacate over 2 — they have a mortality approaching that of patients with a qSOFA of 2.  Be careful just sending a patient who is on the fence to the floor because several studies have demonstrated that patients who are later upgraded have worse outcomes.

Jeff: That’s in line with the general themes we’ve laid out today – definitely better to start early with aggressive care rather than play catch up later.   Jeremy – in 30 seconds or less, what are the most salient points in the management of sepsis that you would like our listeners to take with them from this episode.

Jeremy:  Here are my take aways:

• 
  qSOFA, RR, AMS SBP < 100
• 
  Norepi, not Dopamine – it doesn’t work!
• 
  Be smart about fluids!!
• 
  Be smarter about antibiotic use!
• 
  You are the best advocate for your patient, despite what anyone else says!

Jeff: Excellent, so that wraps up the October 2018 episode of Emplify. A big thanks to Jeremy Rose for joining us. 

Jeremy: Thank you for having me!!! It was great talking with you.

Nachi: For our listeners — additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at www.ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credits. You’ll also get enhanced access to the podcast, including the images and tables mentioned. You can find everything you need to know at ebmedicine.net/subscribe.

Jeff: And the address for this month’s credit is ebmedicine.net/E1018, so head over there to get your CME credit.  As always, the ding sound  you heard throughout the episode corresponds to the answers to the CME questions.

Nachi: Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at [email protected] with any comments or suggestions. Talk to you next month!

5 Signs Of Sepsis You Need to Know About

By now you likely understand that when you have an infection, your immune system works tirelessly—sometimes with the help of medications like antibiotics and antivirals—to fight the invaders that are making you sick. But unfortunately, this battle isn’t always easily won.

When an infection isn’t treated properly or rages out of control, your immune system can go haywire (for reasons doctors don’t fully understand), causing you to develop sepsis, a life-threatening condition in which the body actually injures its own tissues and organs. And it’s no joke. More than 1.5 million people get sepsis each year in the U.S. and at least 250,000 Americans die from sepsis annually, reports the Centers for Disease Control and Prevention (CDC).

If left untreated, sepsis can progress into septic shock, the most severe form of the condition, which “compromises the cardiovascular system and results in very low blood pressure and inadequate blood flow to vital organs,” says Carmen Polito, M.D., assistant professor of medicine at Emory University School of Medicine. Once in shock, you have very low blood pressure that’s difficult to improve with IV fluids and a high lactate level, which suggests you’re not getting adequate blood flow to organs and cells.

Since there isn’t a single test for the condition, sepsis and septic shock are very difficult to diagnose. BUT what doctors do know is that sepsis is most commonly caused by four infections: pneumonia, abdominal infections (such as untreated appendicitis), urinary tract infections (UTIs), or an infection of skin or soft tissue, says Craig Coopersmith, M.D., professor of surgery at Emory University School of Medicine. Signs of sepsis frequently overlap with those of septic shock and both go hand-in-hand with symptoms—like painful urination or trouble breathing—of those primary infections.

So, if you ever experience a combination of infection symptoms and the following, you should seek medical help immediately—no ifs, ands, or buts.

Here are the five main signs of sepsis:

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When experiencing sepsis, your body focuses on pumping blood to the most crucial organs like your heart, kidney, and brain rather than to less crucial areas of the body (think: your extremities), Christopher Seymour, M. D., assistant professor of critical care and emergency medicine at University of Pittsburgh School of Medicine says. Because of this, your skin can begin to feel cold and clammy. And this can either stay the same or get worse when your body goes into septic shock.

But remember: Cold and clammy skin can be a symptom of many less deadly (and even totally benign) conditions, too. It’s only cause for concern if you’re experiencing other symptoms of a primary infection, too.

Related: 7 Sneaky Signs Your Blood Sugar Is Too High

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Because the kidney is one of the most commonly-injured organs in sepsis—particularly since it’s so sensitive to changes in blood flow and pressure—it’s not uncommon for your urine to be affected. When your body senses low blood pressure, it tries to hold onto as much fluid as possible, which results in less fluid in your urine (a.k.a. darker, smellier pee) and causes your kidneys to make less urine (meaning fewer bathroom trips), Seymour says.

Another cause of this symptom? Dehydration as a result of losing fluids through, say, sweating because of a fever, and not replenishing them enough through food and liquids. Together this dehydrating combo can lead to another reason for altered urination: leaky blood vessels, in which fluid leaks out of your blood stream and into your body much like water in a garden hose with a bunch of pin pricks on the side, Coopersmith says. In extreme cases, some patients might even stop peeing entirely. If you’re feeling sick and begin to notice negative changes in your peeing, don’t necessarily blame it on a day’s worth of poor hydration.

This easy water bottle hack will help you stay properly hydrated every single day:

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Confusion, decreased level of alertness, and lightheadedness and/or dizziness can all be the result of low blood flow to the brain, dehydration, and the “bad” toxins released into the body as a result of sepsis. If you’re experiencing septic shock, all of these symptoms will be, in Seymour’s words, “quite profound,” such that they’ll feel like the extreme versions of what you’ve known to be, say, dizziness. Seymour emphasizes again that these signs must be in the presence of an infection to signify sepsis especially since they’re also common symptoms of other issues like a stroke (confusion) or simply tiredness or fatigue.

(Get the latest health, weight loss, fitness, and sex intel delivered straight to your inbox. Sign up for our “Daily Dose” newsletter.)

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This isn’t just your typical amped-up heart rate after a morning run. No, we’re talking about having a speedy heart rate—a feeling like your heart is racing—while you’re, say, simply sitting in a chair. The average Joe’s typical heart rate is between 60 to 90 beats-per-minute, so if you take your pulse and find anything above 90, this could be a sign of sepsis, Coopersmith says. In sepsis your body is revved up because it’s attempting to fight the infection, plus its trying super hard to get blood flow to the damaged tissues. This calls on your heart to increase the amount of blood it’s pumping out, thus speeding up your heart rate to feel like it’s at the Indy 500. Because symptoms do not necessarily progress linearly from sepsis to septic shock, such that they worsen gradually with each level of the condition, your heart rate may or may not get even higher in septic shock.

Related: This Woman’s Viral Photo Reveals A Breast Cancer Symptom That’s Easy To Overlook

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Unless you’re in a meditation class, you don’t typically think about your breathing, right? So if you notice you are breathing rapidly and/or experiencing shortness of breath, as if you just climbed multiple flights of stairs, then you might want to take a deeper look into what’s going on. And remember, pneumonia (think: lungs!) is the most common infection to cause sepsis. Like increased heart rate, these symptoms are a result of your body being in overdrive—in this case, consuming more oxygen and thus producing more carbon dioxide than usual. Because of this, your body needs more oxygen and tries to meet this demand by breathing faster and potentially causing you to feel winded, Coopersmith explains. In some patients, breathing might worsen to the point where they can no longer breathe on their own. Lesson again: Don’t just chalk up your altered breathing to a challenging HIIT class…even hours after it ended. Like Polito cautions, “It’s always better to be safe than sorry.”

Related: ‘I Got Rhabdo After Spin Class’: What You Need To Know About This Woman’s Story

So let us repeat: If you experience any of the above symptoms in conjunction with those of an infection, Coopersmith, Polito, and Seymour all urge you to seek medical attention stat. Why the rush? Because sepsis is “a time-sensitive syndrome,” meaning the damage that occurs happens over hours, not days—plus, there is data to suggest that the faster sepsis and septic shock are treated, the better patients’ outcomes are (think: lower risk of death), Seymour says.

While treatment varies because each patient and infection is different, it’s usually an aggressive process, since docs are faced with challenges such as the condition’s diagnostic difficulty and rapid speed. They’ll first address the underlying infection by administering antibiotics and try to raise blood pressure and volume with IV fluids. Then, they’ll focus on something called “source control,” which involves figuring out the cause of the infection and taking the proper steps—in some cases even surgery or drainage—to control it, Seymour explains.

When it comes to sepsis and septic shock, remember that early identification and treatment are crucial. So, if you’re ever concerned, seek medical attention to reduce your risk of complications. “Septic shock is fatal in 40 percent of cases,” Polito says—so don’t wait.

Elizabeth Bacharach
Elizabeth Bacharach is the Assistant Editor at Women’s Health where she writes and edits content about mental and physical health, food and nutrition, sexual health, and lifestyle trends across WomensHealthMag. com and the print magazine.

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definition in the Cambridge English Dictionary

Others were re-purposed objects, like the converted septic tank shelter.

Back in the day we had dense communities and farms were the only places that had septic tanks.

Septic shock occurs when someone has all of these symptoms plus extremely low blood pressure that doesn’t respond to fluid replacement.

She came back a week later in septic shock and died soon after.

And within four or five days, the body’s blood pressure may decrease and may experience septic shock.

I believe she bought it to be able to use my septic.

The septic regulation rolls back rules requiring new construction to use high-tech systems to reduce water pollution.

Once injected, the substances can take years to migrate to other parts of the body and cause blood clots, septic infections and sometimes death.

In recent years, studies have traced the brown tide to nitrogen pollution flowing from the island’s buried backyard septic systems.

The stakes involved in this decision could not be higher, since treating septic patients early is the single most important element in their care.

But at this point that information is proverbial water under the bridge, or sewage out of the septic tank, you could say.

These examples are from corpora and from sources on the web. Any opinions in the examples do not represent the opinion of the Cambridge Dictionary editors or of Cambridge University Press or its licensors.

What is a septic tank and how does it work – Real time

Device for home autonomous sewerage: septic tank, its varieties and principles of operation

In the previous article, we touched upon a large and important topic – the arrangement of the sewerage system in a country house. We started with a checklist – what you need to check and determine for yourself before solving the sewer issue. Now, perhaps, it’s worth talking about the most popular types of autonomous sewage arrangement – septic tanks.

What is a septic tank and how does it work

A septic tank, or an autonomous sewage system, is the simplest treatment facility, into which sewage flows pass and is cleaned step by step. After it, the wastewater is divided into mechanical sediment and water – the water subsequently, passing through the filtration system (about it in the next article), goes into the ground, and the sediment (sludge) is pumped out by a sewage machine.

The average septic tank of the most popular type consists of two or three chambers.The first one comes directly from the sewage from your home. The volume of this chamber should be sufficient to keep up with everything that your household produces. Usually, the daily sewage flow is calculated, and the volume of the first chamber of the septic tank is made three times larger – just in case and to cope with peak loads (general cleaning, the arrival of many guests, holidays and similar misfortunes). In the first chamber, sludge settles to the bottom, and the settled and slightly mechanically purified water passes into the second part of the septic tank.The first container must have a bottom, untreated wastewater from it must in no case have a direct opportunity to go into the ground.

Organic waste that settles on the bottom of the first compartment of the septic tank decomposes for several days under the influence of anaerobic bacteria. This sediment must be removed periodically. The cleaning efficiency in the first chamber of the septic tank is about 60%, so the water that leaves here needs to be further purified.

The average septic tank of the most popular type consists of two or three chambers.Photo: mosvodostroy.ru

Re-treatment of effluents occurs in the second chamber of the septic tank (if there is one at all, because this stage can be skipped). Here, the re-decomposition of sewage occurs under the influence of the bacterial community. Sometimes industrial septic tanks are also supplied with a chemical cleaning element – for this, special granules with reagents are placed in the compartment, which decompose some chemical pollutants, both organic and inorganic.

And, finally, the process of additional soil purification of wastewater follows – moisture enters the filtration device (we will talk about them later).The water settled and purified from mechanical silt enters here, is filtered through gravel, gravel and sand – and goes into the ground.

Three types of septic tanks

Depending on the device and the principle of operation, septic tanks are divided into three main types.

A storage septic tank is, strictly speaking, not even quite a septic tank. This is a huge tank that performs the function of a cesspool – a single-chamber reservoir in which waste accumulates, and as the tank fills, the sewage is pumped out (with the participation of a sewer truck).The volume of such a container can be from 1 to 4 cubic meters, depending on the size of your household and the rate of effluent production. Accumulative septic tanks are selected if it is impossible to equip a further filtration system (this happens, for example, when groundwater comes very high to the surface of the earth or if the house is located in a sanitary zone, or 100 meters from a river or lake) or if you only use the house on weekends or in the summer, living in the country.

You risk your whole life to depend on the mood and schedule of the vacuum cleaner.Photo: odstroy.ru

This is one of the most difficult options for solving a sewage problem, because in this case you risk your whole life depending on the mood and schedule of the sewer – the regularity of the need to empty the storage septic tank may surprise you.

Sediment tanks with a ground post-treatment system are exactly the same type of septic tank that is outlined in general terms in the first part of this article. It consists of two or three sections and a device for additional ground filtration of waste water.In the storage tank, sewage is settled and decomposed by anaerobic bacteria. Passing from one tank to another, the effluents pass through several stages of natural separation, but the maximum degree of purification of such effluents is not high. For this, ground treatment systems are needed – only after that does the water go into the ground.

Septic tanks with biological treatment, in fact, are a full-fledged station for deep wastewater treatment using the vital activity of anaerobic and aerobic bacteria. After them, water can be safely fed into a storage tank, for example, for watering plants (although few people really go for this – stereotypes are still strong in our society). This is a single sealed unit, reinforced with stiffeners and divided into chambers. Several methods of purification are combined here – mechanical, biological, and often also chemical, so that after that the water is purified by at least 90 percent. Therefore, such septic tanks are the only ones from which water can be drained into a reservoir.No additional filtering is required after them. Such a system also has disadvantages: first of all, it is expensive, and secondly, it is highly volatile. After all, in order for aerobic microorganisms to live and work, the compartment with them must be supplied with oxygen, which means that the aerator must constantly work. If we include a pumping system here, we will get a rather complex technical device. But this is the cleanest and most environmentally friendly way to get rid of sewage.

Such a system also has disadvantages: first of all, it is expensive, and secondly, it is highly volatile.Photo: osnova39.ru

How to position a septic tank on the site

The septic tank must have a bottom and be airtight. Their device is regulated by the standard – STO NOSTROY 2.17.176-2015. This document, which we will definitely study in the future, provides for the following distances of the septic tank from other objects on the site:

• to the house – 5 meters;
• to a well or a well in areas with clayey soil or loam – 20 meters in an area with clayey soil;
• to a well or a well in areas with loam, sandy loam or sand – 50-80 meters;
• to the side of the road – 5 meters;
• to the border of the site – 4 meters; 90,042 90,041 to trees – 3 meters;
• to the bush – 1 meter;
• to a river or stream – 10 meters;
• to a pond or lake – 30 meters;
• to the underground gas main – 5 meters.

Lyudmila Gubaeva

Real Estate Society Infrastructure Tatarstan
90,000 what is it, how it works, types, photo

The dubious comfort of an ordinary cesspool today is no longer satisfied with anyone. The need to frequently call flushers with constant use is far from the only drawback. The septic tank is becoming more and more popular – what it is should be considered in more detail.Summarizing, we can say that such a system provides for the possibility of waste recycling. As a result, the degree of comfort increases and the risk of unpleasant situations is reduced – the appearance of odor, the ingress of harmful substances into the soil, etc.

Types of septic tanks

There are quite a few septic tanks, if you take into account the variety of ready-made models from well-known manufacturers, designs, their varieties and the choice of materials for self-production.

Depending on the number of chambers, the following options are possible:

• single-chamber models (slightly differ in efficiency from a cesspool, this design is more of a suburban septic tank than a device for a home with permanent residence),
• two-chamber,
• three-chambered.

Single-chamber septic tank (storage tank) needs regular pumping

In models with several chambers, wastewater treatment is carried out in two ways:

• mechanical (sedimentation of impurities),
• biological (decomposition of organic inclusions with the help of bacteria).

The more chambers, the higher the efficiency of the utilizer, if, of course, the design and its performance are chosen correctly, and no violations were allowed during construction.

Finding out what septic tanks are for sewage, they are often interested in how high the degree of wastewater treatment is when they are used.

Additional parameters for the classification of septic tanks are the type of bacteria used to decompose organic matter and the volatility of the models. These characteristics are related to each other.

• In simpler designs, anaerobic bacteria that do not need oxygen work, so there is no need to install special compressors, ventilation pipes are enough to ensure normal operation of the device. An autonomous septic tank that does not need additional devices (and therefore does not need to be connected to the electrical network) is convenient where power supply instability is observed (voltage drops, shutdowns, etc.).
• The volatile septic tank is more complex – what it is is easy to understand by imagining a complex installation with compressors, several treatment methods (mechanical, biological) and additional devices (airlift, etc.). Not all of the listed types of equipment must be present in the design of one model.There are more or less complex options.

The photo shows a diagram of a deep biological treatment plant

General principle of operation and nuances

In septic tanks, wastewater treatment occurs in stages.

• In the first chamber there is a preliminary sedimentation of impurities and separation of effluents into light and heavy fractions.
• The second chamber, like the first, is a place of active work of anaerobic bacteria, which decompose the organic matter remaining after the first chamber and turn it into a sludge mass. This decomposition has several advantages. Firstly, it excludes the occurrence of putrefactive processes with the formation of a strong unpleasant odor. Secondly, the resulting sludge takes up a smaller volume, so the septic tank has to be cleaned much less often than a conventional cesspool.
• In the third chamber, the remaining particles of inclusions are also deposited on the bottom (if the liquid is discharged into the filtration field) or on the filter bed (gravel, crushed stone, etc.) in chambers without a sealed bottom.

The first two chambers of the septic tank have a sealed bottom, and the bottom of the third chamber from the gravel backfill passes wastewater into the ground.

Liquid flows from the chamber to the chamber through openings in the upper part of each tank.This allows the purified water of the upper layers to be delivered to each subsequent container.

Selection criteria

Even if you have thoroughly studied septic tank sewerage: what it is and how it works, such information is not enough for the correct choice of the finished model or for making calculations during construction. It is also necessary to assess the operating conditions.

For maximum efficiency, a purchased or self-built model must meet the following operating conditions:

• Capacity .The total volume of chambers, regardless of their number, should not be less than the average daily water consumption of all family members (about 200 liters per person), multiplied by 3.
• Soil type and groundwater location . Models with a filter bottom are not recommended for high groundwater levels or when they rise significantly during floods, and on clayey soils and loams with low cultivation capacity.
• Power supply quality .In case of interruptions and instability of the network parameters, volatile equipment will require expensive additional equipment, including the installation of a generator, a stabilizer, otherwise the system will not work correctly, and the equipment can quickly fail.

How to make a septic tank for a private house with your own hands, read in a separate material on the site.

If you are interested in how a drain pit is made in a private house or in a country house, then you can read about this in another article.In some cases, it may also be relevant.

And about the choice of a pump for a well, you will find information here.

Buy or Build?

Before evaluating the advantages and disadvantages of purchased and self-made structures, it is important to consider that not every septic tank in a private house can be built with your own hands. Treatment plants (VOC) with the maximum degree of wastewater treatment and the possibility of using the resulting liquid for irrigation can only be factory-made.The complexity of their device does not allow DIY construction.

Benefits of purchasing a ready-made septic tank

1. Save time. It is enough to carry out earthworks and, if necessary, equip the foundation, after which you can install the product and connect it to the system.
2. Parameter accuracy. Geometric parameters, productivity and other operational characteristics of finished models and design features are carefully calculated, and the accuracy of calculations has been proven by practice, therefore, a violation of the operating mode due to an error is excluded.

Disadvantages of acquisition

1. A ready-made septic tank will cost more than building materials and components for making your own hands.
2. Standard dimensions impose some restrictions in terms of the way the structure is placed on the site.

Self-Building Benefits

1. Cost savings.
2. Possibility to create a model with individual parameters (number and volume of chambers, geometric dimensions).

   Construction of a septic tank from euro cubes

Disadvantages of DIY

1. Construction will take some time. The production time depends on the material chosen, for example, the use of concrete rings or plastic Eurocubes increases productivity, the choice of brickwork or the construction of a structure made of cast concrete will increase the production time.
2. It is necessary to have certain skills and experience in this area.

Popular Models

Tank

A family of block non-volatile structures, convenient in installation and characterized by high efficiency.Sludge pumping when using biobacteria is required every 1.5-2 years. It is necessary to use additional soil treatment, which will require the purchase and installation of an infiltrator.

Septic Tank with infiltrator

Topas

Volatile and quite expensive models. The degree of purification is up to 93-98%. Does not require cleaning with a vacuum cleaner. Other advantages are high strength characteristics, no need for complex soil preparation before installation. There are modifications with different performance.

Rostock

Septic Rostock is a monolithic structure with a plastic body, divided into 2 sections. The first stage is the primary filtration of effluents, the second is additional purification from sludge. To prevent “roiling” (sludge rising from the bottom) when the liquid is overflowing, a flow damper is installed. The model is capable of removing up to 70-80% of impurities; mesh and sorption filtration methods are used.

Having understood what a septic tank is and how it works, you can proceed to determining the parameters and performance characteristics required for a particular object.When evaluating and comparing options (independent production, purchase), materials for manufacturing, a method of water drainage and other features, the cost of the project and the economic feasibility of certain costs are also taken into account. For example, the installation of expensive VOCs is justified in the sewage systems of houses with permanent residence, and a simpler and cheaper design, up to a storage tank, may be suitable for a summer residence.

What is a septic tank, what is it for and how does it differ from a drain pit?

In one of my “writings” I made a reservation that a septic tank and a drain (= cesspool) are not the same, despite some similarities, there are still differences.Therefore, I wrote a number of articles about septic tanks (I even believe that I will not limit myself to written articles: in the course of studying the topic of septic tanks, I came up with several interesting ideas, one of which I shared in an article about how a septic tank works). This is the first article, and it explains in detail, what a septic tank is, how it differs from simple drain pits, what are the pros and cons, what a septic tank can be made of, etc.

To begin with, let’s put everything in its place in the head: we will define exactly what a septic tank is.This must be done because the same aeration tank is increasingly hidden under the name “septic tank”. It’s not the same though. Yes, aeration tanks are called Bioseptics in a different way, hence the confusion …

What is a septic tank?

Here is the definition of what a septic tank is:

– a septic tank is a structure for the treatment of domestic wastewater, which is a horizontal underground sedimentation tank with 1-3 chambers through which wastewater flows sequentially:

Mechanical and partially biological wastewater treatment takes place in the septic tank chambers, after which they (wastewater) are sent for final treatment through underground filtering structures into the soil.

In this article I will not specify what a BIOseptic (aerotank) is, but rather, I will once again clarify the “main signs” of septic tanks. Here they are:

– horizontal;

– the presence of one to three cameras;

– wastewater treatment in a septic tank is only partial, one might say primary;

– wastewater from the septic tank must be sent for additional treatment into the soil through – necessarily! – underground filtering facility.

What is a septic tank for?

If I repeat myself in anything, do not consider it neither insanity, nor paranoia, nor sclerosis: this is how it should be.

So, the septic tank has the following purposes:

– preliminary mechanical wastewater treatment. Such cleaning is necessary so that underground filtration facilities are less clogged, which means that they serve longer;

– decomposition of the precipitated sediment. This decayed sediment can then be removed from the septic tank and used as a good, high-quality fertilizer for a garden, vegetable garden, etc.

Attention! If you have a septic tank filled with such rotten “good”, and now, after reading the lines above, you decided to urgently clean everything up and spread it out in the beds … DO NOT DO THIS! First, read the article on how to use rotted sludge from a septic tank for fertilization.

What is the difference between a septic tank and drain (cesspools) pits?

The difference from the drain pit is obvious.

In the drain pit, drains accumulate and “wait” for the arrival of the sewer, or, again, “wait” for them to seep into the soil through the bottom or leaky pit walls (if the drain pit has no bottom):

In a septic tank, the drains are pre-treated, flowing from one chamber to another (if, of course, there are more chambers than one).

The septic tank allows you to use devices that require much more water consumption than a simple drain pit.What are these devices? In my opinion, and so it is clear, for example, a washing machine …

In general, a septic tank does not fill up as quickly as a simple drain pit. What to do at home, the choice is yours, because you need to take into account the possibilities of the wallet, the area of ​​the site, the entrance for pumping out the drains.

What material to make a septic tank from?

Septic tanks (and simple drain pits) can be made of different materials: reinforced concrete, concrete rings, plastic, metal, brick, even car tires. In general, there are many options, we focus on our capabilities, needs and take into account the pros and cons of this or that material (the main criterion here is reliability, durability, after all, probably, no one wants to have an ecological disaster, even if it is in the size of “only” their site? ).

So, when choosing a septic tank made of steel, it should be borne in mind that such a septic tank has certain disadvantages. Probably the most significant – ordinary (black, not stainless steel) steel under the influence of “good” quickly decays, which means that if you make a septic tank from steel, then the steel should be thick (from 5 mm and more).Well, a septic tank made of stainless steel … I don’t know which of the readers of my site can afford this, for some reason it seems that the oligarchs are hardly interested in how to make a drain pit with their own hands …

I will clarify as long as I remember: both plastic and metal containers for septic tanks need to be anchored in the ground – attached to a concrete slab poured into the bottom of the pit. Otherwise, under the influence of heaving of the soil, your septic tank will float up in the very first winter.

To speed up installation and for greater reliability, many ready-made septic tanks are now produced, for example, fiberglass:

Plastic:

Steel:

And even concrete:

Their installation consists only in installing them on site and supplying pipes from the house.

For the construction of a septic tank with your own hands, concrete rings are often used, but lifting equipment is required to work with them. Well, the entrance for her to the site. Therefore, in order to do without special equipment, you can use a concrete solution to fill the walls of the drain pit in an already prepared pit on your own. Or lay it out with red bricks.

But for the installation of plastic septic tanks, other lifting “equipment” is often not required, except for three or four people:

For the convenience of pumping out accumulated drains, an opening lid should be provided in the roof of the septic tank. The material for the roof must be chosen strong and durable.

The following articles describe in sufficient detail how to make a septic tank or drain pit from the materials listed here.

Pros and cons of septic tanks

The septic tank itself is relatively easy to arrange, and depending on the materials chosen, it may not be expensive … This is a plus.

Less, as you probably already guessed, in the need for additional treatment of wastewater that has passed through the septic tank. That is, the need to create such “things” as filtration fields, filtration wells or trenches, etc.The listed devices have a very big and fat minus – their arrangement is laborious and costly in finance, and their cleaning and restoration is even more costly. It is necessary to clean and restore underground treatment facilities due to the fact that they become silted over time, which is why they lose their filtering properties. But you can’t do without them either! Because they have a very effective soil filtration and biological treatment of wastewater that has passed the septic tank.

In general, the installation of underground filters requires, first, compliance with certain conditions related to “geology”; secondly, significant labor costs both at the beginning and during further operation.To extend the service life of filtration fields, etc., septic tanks are made with several sections – for more thorough cleaning of wastewater inside the septic tank itself … However, read about all this in detail in the articles about these devices.

Another disadvantage: in winter, the efficiency of wastewater treatment can be generally zero due to freezing of the soil.

And one more thing: no matter what sophisticated devices we add to the septic tank, it is impossible to clean the effluent from such harmful substances as nitrates, nitrites and other phosphorus.

Well, the last thing: you still need to pump out the accumulated sediment from the septic tank, so you can’t do without a flusher. And then, is it worth the candle?

(However, a minus with pumping out a septic tank can be a plus – for lovers of gardening fuss: sediment from a septic tank is a good and free fertilizer. And if you are one of those amateurs, then you will live without a sewer, having learned to pump out of the septic tank yourself.And then your autonomous sewage system will be truly autonomous … but I will not get ahead of myself, there is a separate article about this ahead.)

So, I hope we figured out what a septic tank is, what it is intended for, got a general idea of ​​how this “thing” looks … well, and we will not confuse it with anything else.

what is a septic tank

What is a septic tank? Why do you need a septic tank for a country house.

Owners of country houses, in which there is no possibility of connecting to the central sewerage system, in most cases use cesspools.But nowadays more and more people think about ecology, and especially those who drink well water. And they know that a cesspool, even at a neighbor’s, can spoil your well water. And especially, this chance increases with highly flowing surface waters. That’s when many are inclined to drill a well (after all, you don’t really want to drink what a neighbor leaves in a cesspool) and install a septic tank on your site (so that someone doesn’t drink what you leave behind). And this is absolutely the right decision.But it’s still worth figuring out what a septic tank is.

The septic tank is a system for the treatment of domestic and domestic waste water based on the principle of gravitational sedimentation of accumulated masses and biologically natural post-treatment with the correct use of various and effective bioferment preparations.

Well, you might think. But under these difficult phrases is a very simple principle of the septic tank. Namely – the accumulation of waste water and its purification with the help of the vital activity of some kind of bacteria.More precisely, a septic tank was created to optimize and accelerate this process. It collects waste water from your home and cleans it with bacteria. That is, as a result, the water that comes out of the house with an installed septic tank cannot harm the environment, does not pollute the soil and groundwater. If you are interested in the detailed operating principle of a septic tank, then we suggest reading the article “Septic tank device”.

At the outlet of the septic tank, 98% purified water is obtained, which can be used for irrigation of a lawn, garden or flower bed.Or simply send it to the ground for additional treatment in a natural way. And thanks to the circulation of water, it will again become pure drinking water or the usual habitat for someone.

Thus, you can be completely sure that the septic tank helps to preserve the ecology and natural water supplies. And that your waste products will not harm anyone.

We hope that now we fully understand what a septic tank is and why it is needed.

90,000 what is it, sewerage systems for a private house, how it works, what the device looks like, construction, sewer

Many people in their summer cottages and country houses use a septic tank as treatment facilities, but not everyone knows what design they need and how the system works in general.So what is it – an autonomous septic tank in a private house and how does it work?

Sewerage septic tank in a private house: what is it

Sewage septic tank is a special treatment facility (for a country house) that operates without electricity consumption, where waste water is processed in a sump, the underground filtration system decomposes without oxygen.

How such a system works

The treatment plant can be located up to 20 meters from the building, the dirty water flows through the outlets into the general tank. Elements that cannot be dissolved remain at the bottom, and with the help of anaerobic bacteria, the water part begins to ferment. During the life of bacteria, methane is released; for its removal, a pipe installed 1-2 meters above the roof of the building is used.

From 50 to 75 is the percentage of water purification, after which the incompletely purified liquid flows into the soil for final purification. The insoluble sediment that accumulates at the bottom of the septic tank is cleaned out by the pump of the sewage machine.Depending on the intensity of use, cleaning of the structure is required from 1 time per month.

To improve the quality of wastewater, a specialized biofilter is installed in the system, the most common version of expanded clay.

Here, wastewater can be treated aerobically, that is, with the use of oxygen. Before the water enters the biofilter, it is clarified. After, anaerobic bacteria break down impurities, turning them into sludge, the resulting filter cake needs to be removed after a certain period of time.

The percentage of water purification in such a design is much higher and is about 90%. Once the water is purified, it enters the well to recycle the remaining impurities using aerobic bacteria and oxygen. In this interaction, all elements are finally decomposed. To completely purify the liquid, the next stage will be to drain the water into the soil.

Read also the material about the Aerator for the sewage system, about pumping out the sewage system, country toilet bowls and conducting water from the well.

The most common and effective wastewater treatment method is underground filtration. For the arrangement of the system on the ground, layers of filter sand will be required.

The structure is made of pipes with small holes, lined with gravel around the perimeter. This cleaning system has a small throughput and is suitable for families of 2-3 people.

To increase the volume, use additional filtering layers of gravel and sand, with the use of additional cleaning trenches.

Types of septic tanks for the home

Cleaning systems are divided according to the principle of operation:

• with soil filtration;
• with biological treatment;
• cumulative.

Septic tanks are divided according to the material for the manufacture of structures:

• plastic;
• brick;
• reinforced concrete rings;
• metal.

Designs differ in the way of installation and shape:

• vertical;
• horizontal.

Wastewater treatment plants can be installed both on the surface of the earth and underground.

Which pump is optimal for water supply from a well?

How to quickly remove a blockage in a sink?

Wall hung toilet – a new solution for the toilet.

Classification of septic tanks

The choice of a particular type of construction depends on the intensity of use and a calculation of the daily throughput will be required.

The septic tank is cleaned using the pump of the sewer truck.

The storage septic tank is presented in the form of a tank where waste water from the building is collected. The principle of operation of the device is simple, all the incoming mass is divided into heavy fractions that settle at the bottom and light impurities that float up.

In modern cleaning devices, the liquid is stored in a container until the stage of cleaning. The containers are cleaned as they are filled using a special equipment pump. The main advantage of the design is ease of use, and the disadvantage is the need for constant cleaning during operation.

Storage-type devices are recommended for use in buildings that are not intended for living all year round, for example, in summer cottages. When choosing a septic tank, for smooth operation it is necessary to take into account the following factors:

• it is better to choose a capacity of a large volume, in the future it will allow you to reduce the cost of the services of the sewage brigade;
• , the structure of the tank must be made of high-strength material so that the tank is not damaged during operation under soil pressure.

If permanent residence is planned in a country house, then it is better to choose an overflow design of a septic tank, here not only the liquid is drained, but also purified .With the help of such a device, you will have to call a sewage truck a maximum of 3 times a year.

To increase the time between tank cleanings, bacteria for septic tanks are also used, with the help of them you can significantly reduce the mass of undecomposed particles.

Advantages of the cleaning system:

• septic tank is easy to maintain and use;
• waste water treatment;
• Saving money on the services of sewage equipment

Installation of the cleaning structure must not be carried out on clay areas .The disadvantage of this type of septic tank is that it will not be possible to produce a functional filtration field if groundwater is located close to the surface, and it is also impossible to install on clay soil.

DIY installation of an autonomous sewage system

Do-it-yourself septic tank construction takes place in several stages.

Calculation and construction of a pit

To dig a pit with the correct parameters, you need to accurately calculate the daily volume of wastewater discharge, increase the data obtained by 3 times with a 20% margin. The volume of the first chamber of the septic tank is equal to the volume of the drain. 30% of the volume from the first chamber is the second. The approximate depth of the pit is 2.5 meters, here it is required to take into account the composition of the land where the treatment plant is installed.

From the bottom of the 1st chamber, the lower edge of the drain pipe should be located 80 cm.

Construction of internal formwork

The construction of a concrete septic tank will be considered here, you can also use plastic containers, reinforced concrete containers and other material.

The construction of the formwork takes place according to the parameters of the future septic tank, that is, the pouring takes place in two parts. A 10 cm tee is used as a partition. The upper edge is 2-5 cm below the drain pipe.

Filling the walls of the structure with concrete

The filling is done in several layers, everything is compacted, strengthened with a stone. After pouring the next layer, time is given for complete drying. It is required not to forget about the hole for the drain pipe.The partition is poured at the same moment as the walls. As a result, a one-piece structure is formed. Any metal is used for reinforcement, and fine crushed stone or gravel is used to dilute cement.

Septic tank roof construction

After the construction of the walls for 3-4 days, the structure of the septic tank is left to dry completely so that the concrete gains its maximum strength. The septic tank is closed with a wooden flooring made.

Metal reinforcement is installed from above, if necessary, in some places it can be nailed .

Formwork is installed in one plank of width along the perimeter of the cleaning device. A ventilation pipe of 5-10 cm is installed in the ceiling of the 2nd chamber, it should be 2-3 meters higher than the ground level, in the ceiling of the 1st chamber it is required to leave a connector under the hatch.

The lid is filled with 15 cm layer of concrete, crushed stone is the filler. After the concrete has completely dried, the surface of the cover is completely covered with earth, the resulting area is used for its own needs.

If the design of the septic tank in the 1st chamber is made with a blank bottom, and a layer of rubble is placed in the 2nd chamber, then additional soil treatment will not be needed, the main thing here is to correctly calculate the required volume.

The process of installing a septic tank in a private house with your own hands is shown in the video:

As you can see, There is nothing complicated in the construction of an autonomous sewage system , but this business requires a special approach and responsibility.The entire processing process is carried out by bacteria, and we create all the conditions for their life.

On the construction market there are many designs of septic tanks that can be used in almost all conditions, even in cases of clay soil or close flow to the surface of groundwater. There are treatment facilities where the filtration of wastewater occurs up to 100%, and therefore the discharge of liquid can occur in rivers, lakes or on the ground.

90,000 What is a septic tank and what is it for?

Many of us strive to create comfortable conditions for living and spending time, even in suburban conditions.

What difficulties does a summer resident face during his summer residence in the country?

Perhaps the biggest inconvenience is the lack of a sewage system.

The same problem worries many owners of country houses who do not have the opportunity to connect to the central sewerage system.

Currently, many options have been invented to solve this problem, one of which is the use of septic tanks.

What is a septic tank? What is it for? We will consider these and other questions in detail in this article.

Septic tank (translated from English “putrid, purulent”) is a sump, a local element of a treatment plant, the purpose of which is to collect wastewater and sewage with or without their further processing.

The main parameters that distinguish different types of septic tanks:

• Similar structures are usually made of plastic, but there are also options made of: metal, reinforced concrete and brick.
• Usually the septic tank is installed underground to save space. The most cost-effective way to install is on the surface.
• By the type of location, septic tanks are divided into horizontal and vertical.
• According to the type of work, septic tanks are: storage (sealed and not sealed), with bio- and soil cleaning.

Septic tank “work” mechanism

Wastewater, faeces, etc. enter the tank, as the tank is filled, the incoming liquid is purified in 3 main ways: mechanical, chemical or biological.

The degree of purification in the end will depend on the design of the septic tank and the chosen method of purification.

For what purpose is a septic tank needed?

As already indicated earlier, a septic tank is a place for collecting waste; in the process of purifying water that has passed filtration, it is quite possible to use it for agricultural needs.

The septic tank prevents pollution of the environment: water bodies, groundwater and soil.

The cleaning process in a classic septic tank usually consists of 3 stages:

1. Collection of waste water from the house.They are concentrated in a collection well. In the process, solid sewage settles to the bottom, and the lungs fall into the next tank.

Because a well is a sealed container, and in the process of decomposition of solid waste, a dangerous gas is formed in it – methane. Therefore, the design assumes a ventilation system.

There are also structures with mechanical separation of waste, using a mesh.

2. In the second compartment, the effluent is filtered.
3. Next, the purified water passes into the 3rd compartment, where it is exposed to UV rays.
   

So, if you decide to establish a life in the country, which septic tank should you choose? What are the criteria to pay attention to when choosing?

• Performance.

In order to determine this indicator, manufacturers recommend proceeding from the number of people living in the house. On average, one person has 150 liters per day. Based on this, choose a septic tank with a “reserve”.

• Compatible.

This or that model of septic tanks is designed for different types of soils and relief features

• The cost of the septic tank itself and installation.

It is worth considering the factor of costs for further maintenance.

• Availability of free space.
• Does your site have an uninterrupted electricity supply?

As a result, it can be generalized that when choosing a model of a septic tank, you must proceed from practical considerations. In the next article, we will take a closer look at what types of septic tanks are now the most popular, as well as which septic tank to choose for a summer residence.

90,000 is… What is a septic tank?