The Infection Chain Reaction: The Kyle Busch Tragedy

On the latest episode of Going Under: Anesthesia Answered, we walk through the reported details around Kyle Busch’s surprising death and translate the headlines into a clear medical timeline from sinus symptoms to pneumonia, bacteremia, and sepsis. We also explain why “coughing blood” can be a sign of severe lung injury like ARDS, and what early treatment might have changed. 

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Transcript

Pocket Ultrasound That Changes Practice

SPEAKER_01 0:16

This is going under Anesthesia Answered with Dr. Brian Schmutzer on Bahit Sodter's Honey. We're brought to you by the Butterfly Network.

SPEAKER_00 0:23

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The Reported Death And What We Know

SPEAKER_01 1:28

All right, today we are talking about RIP Kyle Bush and kind of the medical explanation behind his uh surprising death, which was May 21st of this year, a week after he won a truck series event. That's right.

SPEAKER_00 1:45

And the caveat is I have no independent knowledge of this besides what been what's been published in the news, so I cannot make a definitive diagnosis. But we're gonna talk through sort of what the news had to say, what that kind of means from a medical perspective, and then you know what what my thoughts are on what happened and potentially why it happened.

SPEAKER_01 2:04

So he was racing in the NASCAR Cup series. He's won it twice, one of the greatest NASCAR racing champions of all time. Uh got his start in Las Vegas a number of years ago, back in the his brother, I would say eighties and nineties.

SPEAKER_00 2:20

Older brother is Kurt Bush, that's right, who won a bunch of races as well. I used to watch a lot of NASCAR with my dad um back in the day and actually did um NASCAR uh fantasy. Fantasy NASCAR. Did you really?

SPEAKER_01 2:30

Oh yeah, yeah, yeah. It was great. And kind of interesting we're doing it today because it is the running of the E 500 today. Um so let's let's just talk about what has come out in the news because when we heard about what happened, um it was you know, he went to the hospital because possibly he was coughing blood. Right. The the and then he was unconscious, the family put out a statement on social media and said that we asked that you, you know, respect our privacy and and respect our privacy, and then all of a sudden the news comes out that he has passed away. Um so walk us through, I guess. Now that it's come out a couple days later, we're finding out that he possibly the initial diagnosis was pneumonia untreated sepsis.

SPEAKER_00 3:20

Yeah, so so just just for background, Kurt Bush, or I'm sorry, Kyle Bush is a was a 41-year-old, healthy guy. I mean, these these NASCAR drivers and indie drivers, they're in pretty good shape. Well, I mean, the exception of a few who later in their career got a little bit bigger. But right, you know, Kyle Bush at 41 was in in exceptionally good shape, um, won a bunch of races. He actually drove, I think he drove all the different series. So, you know, the truck series. Right. For those who don't who don't know NASCAR, there's a truck series, which is sort of like, you know, the lower level series, and then there's another series in between, and then there's the the you know higher level championship series. And so um he drove all of them just because I think he he loved to drive. Um, you know, his older brother Kurt Bush won a bunch of races as well. So um, you know, we're looking at an otherwise healthy guy in his early 40s, which is kind of like you and I. Um just just talking about what probably

Sinus Symptoms Steroids And Missed Treatment

SPEAKER_00 4:16

happened. So it sounds like he was in a race a few days before, maybe a week before, um, where he's he thought he was having some sinus problems, and so he wanted a shot afterwards. Best guess that shot was a steroid that reduces the inflammation, can help with a sinus infection.

SPEAKER_01 4:30

So do you think this had anything to do? Because the race was in, I think it was kind of in the mountains in New York. Anything with altitude or probably did probably didn't matter, yeah.

SPEAKER_00 4:39

Or the poconos or something. Yeah, it probably didn't matter. Um, you know, most sinus infections, it's uh that's kind of 50-50, whether it's a viral or a bacterial infection. Potentially he had a bacterial sinus infection, which if you don't treat it with antibiotics, can worsen. Your sinuses are connected to your lungs. So again, this is all completely um based on conjecture. Yeah, we we have no independent knowledge of this, but potentially he's got a sinus infection that's a bacterial sinus infection, it goes down into his lungs. The pneumonias that make you really sick and kill you are typically the bacterial ones. There are some pneumonias that are viral, they can be very serious as well, but don't typically progress to like a sepsis type type issue. So, you know, he's got that. They give him a shot of steroids, which makes him feel better, but doesn't treat the actual infection because while viruses, you know, your body just kind of handles on their own. Usually bacteria, you need some sort of antibiotic. So potentially that goes to his lungs, potentially then he, you know, continues to race, doesn't slow down, doesn't take an antibiotic, doesn't get proper rest and recovery and all that kind of stuff, gets back, and I think he then was in a race simulator training, yeah, and felt terrible, passed out, and started what they said was coughing up blood. And we'll talk a little bit about that later. My my guess is that it wasn't actually coughing up blood. It was more of a um when you get something called pulmonary edema, um, there's a like you get leaky capillaries, and so it looks like this it's like this frothy, almost like pink sputum that comes up, and so that's not it looks a little bit bloody, but it's not truly like coughing up blood where you would have if you had like a you know bleed into your lungs. So um, yeah, best best guess is it was some sort of bad pneumonia. Um, there's a lot of different bacteria that can cause pneumonia. Um and we we see this a bit, um, and I you know I'm not in the in the emergency room anymore, but talking to some of my emergency room colleagues, we can see this in young 18 to 50 year old men who get really bad pneumonias. And if they don't get in and get treated, they can get very, very sick. Um so you know, best guess, that's what happened.

Pneumonia To Bacteremia To Sepsis

SPEAKER_00 6:54

He got that pneumonia. As the pneumonia started to progress, he got something called bacteremia. So when you don't treat a bacterial infection, sometimes that bacterial infection goes from whatever's infected lungs, leg, heart, whatever, into the bloodstream. And so then it's bacteremia. So bacteria and then emia blood. So bacteria in the blood. Now that in and of itself doesn't mean that it's sepsis. So we'll have to define sepsis here at some point, too. But so pneumonia goes into the blood, starts to get sicker. Now, what sepsis is is a combination of things. So it's your body's response and then also an infection source of that bacteria in the blood. So and this is a little bit complex, but basically, when you get sepsis, you have to meet criteria for what's called SERS, S-I-R-S, systemic inflammatory response syndrome. And so there's four criteria for that. It's based on blood pressure, heart rate, temperature, and um blood pressure, man, I remember don't remember the fourth one. Blood pressure, heart rate, temperature. Um, well, darn it. You'll have to look that up for me. I don't remember the fourth criteria. I'm on it. Yeah, I'm on it. I I don't do this kind of medicine anymore. So oh, here we go. First thing to pop up here's criteria. Yeah. Blood pressure, uh, either low or high, but typically low. Heart rate, typically high, above 90. Temperature, just meaning you've got a temperature above 100.

SPEAKER_01 8:20

I feel like I'm I'm quizzing you for white blood cell count.

SPEAKER_00 8:24

White blood cell count, yes, yes. So you've got to have an elevated white blood cell count showing that there is some sort of inflammation going on. And to be fair, people think about blood white blood cell count as only infection. That can be an inflammatory response of any sort, too. So you got to meet those four criteria, at least two of them, I believe, to meet SERS criteria.

SPEAKER_01 8:43

I'm just while you're explaining this all SERS, pneumonia, sepsis. Oh, there's more, there's more acronyms to come, but go ahead. I'm just thinking in my brain, how rare are all of these in a healthy 41-year-old male who's never experienced anything like this before?

SPEAKER_00 9:04

Uncommon, but not rare. So we we do see again, we see young, and I would consider that young, 20 to 50, young, especially males who in general don't take as good a care of themselves, come in with like rip-roaring pneumonias. Now, most of them aren't highly tuned athletes who are ignoring the symptoms to go race cars, but they're so he probably had a cold or some sort of respiratory. So, based on what I heard about that one race, he was talking about how bad his sinuses hurt. So maybe he had a sinus infection. And so a cold, an upper respiratory infection is almost always viral. So, again, you can get a viral pneumonia, but that doesn't usually cause overwhelming sepsis. Sepsis is almost always caused by a bacteria. So, my guess, again, not knowing anything specific about his case, is he had a sinus infection that he didn't treat with an antibiotic that went into his lungs. You know, they're all connected, right? So that would be my guess. It wouldn't just be it wouldn't just be a cold. Um, okay, so so surge criteria, like I said, and then he's got that bacteremia where he's got um the bacteria, whatever it was, in his blood. And eventually, over time, all of that stuff comes together and shuts down your organs. And so typically what happens first is your kidneys start to shut down. Um, and then you know, you you get all kinds of things like all the all the um nasty substances build up in your blood, right? That your kidneys filter out, you stop making urine, you start to feel terrible, right? People with sepsis feel awful. Would this be like is this a quick yeah? It can happen within six hours. Oh, yeah. I mean, it can not like two days. This is yeah, yeah. So the whole the whole progression of sepsis is longer than that, but going from sepsis to what they call severe sepsis and then septic shock can happen in hours. Um, and then then other things shut down. So, like your your heart starts to shut down, so you get hypotension, low blood pressure, uh, liver, all kinds of stuff. What probably happened to him, and again, I'm totally surmising this based on what people said, but my guess is he got what's called ARDS, acute respiratory distress syndrome.

ARDS And The Pink Frothy Sputum

SPEAKER_00 11:13

So that's sort of like the functional equivalent of sepsis, except in the lungs. And so what when that happens, so he's already got a knock to the lungs because of the pneumonia, he gets this overwhelming inflammatory response and sepsis, and then that starts to attack the lungs, and it makes the capillaries, the blood vessels where the veins and arteries connect on the outside of the lungs start to be really leaky. Okay, and so a bunch of fluid and blood comes into the lungs, and then as that happens, you start to cough that up, and and it basically causes a pulmonary edema as well. So that's what I'm talking about. That pink, like frothy fluid, yeah, it almost looks like um like melted strawberry sherbet that he would cough up. So I'm guessing when they called and said he's coughing up blood, that's probably what he meant.

ICU Care Antibiotics Fluids Ventilation ECMO

SPEAKER_01 12:00

And how like how do you treat that?

SPEAKER_00 12:03

Yeah, so it's all supportive treatment. So the the treatment of Because it's a virus still. Well, it's a bacteria. Yeah. But you would have to you so you you're treating the bacteria with antibiotics, right? So early sepsis. So let's say he went in as soon as he noticed that he like the sinus infection was getting worse. He went in. He got treated with either oral or tip more typically IV antibiotics. Typically, they put you in the hospital for a couple of days, they treat you with IV antibiotics. Once they treat the infection, the sepsis, the SERGE stuff resolves and you're fine. Once you get into that septic kind of you know, swirling down the drain type thing, um, at that point, there's all kinds of supportive care. So you would have had to bring him into the hospital, you give him antibiotics to treat the infection, you give him a bunch of IVs and a bunch of IV fluid to treat all the hypotension and all the shock symptoms. Um, you know, if he had if he truly did have ARDS ARDs, the lung infection or the lung issue, you would probably intubate, you would treat that that way. There'd be all kinds of suction and percussion things you have to do. Then oftentimes, if people have really bad ARDS, you you put them in a prone position. It allows the lungs to actually bring you know oxygen into the body a little bit better. And then kind of the the final Hail Mary thing you can do is hook them up to an ECMO machine, which is like a heart-lung bypass machine, um, kind of like people did for COVID. Sure. Um, and so you'd put them on that for a couple of days till you could clear the infection so that you could still oxygenate his blood. So there's a lot of things you could do, but once at some point it gets to the point where you just you can't treat it anymore. And I'm assuming, you know, when when that 911 call happened, he's laying on the floor coughing up what I assume is pulmonary or uh uh pulmonary edema fluid. At that point, it's probably too late. I mean, no matter what they did, they I mean they could have brought him in the hospital, it's probably too far gone at that point.

Why Athletes Ignore Warning Signs

SPEAKER_01 13:53

Well, and and a lot of people at that point, I mean, not at this point, but a lot of people, I know I have in the past, you kind of ignore especially men. Yeah. If you have a sinus infection, you're like, I just have a sinus infection, it's not that big of a deal. Is this kind of an unfortunate warning?

SPEAKER_00 14:14

Yeah, I mean maybe. I mean, it's pretty it's still it's not rare, but it's uncommon that a sinus infection turns into pneumonia that turns into sepsis that turns into to killing you.

SPEAKER_01 14:24

So again, it's I mean, you gotta be ignoring those signs for sure at that point.

SPEAKER_00 14:29

He would have had some pretty severe, you know, shortness of breath and fatigue and all that sort of stuff when he got the true pneumonia. Um, but also you've got a guy who and and I'm not blaming the doctors, so again, I don't know the situation, but if I'm his physician and he like because these guys are are seeing physicians constantly.

SPEAKER_01 14:47

100%.

SPEAKER_00 14:48

So if I'm his physician, I'm like, no, you're not getting in the simulator, you're not racing today, you're going to the hospital right now. So I don't know. I mean, and it's not like the the physician could have like physically drugged him to the to the hospital, but you would think somebody who's seeing physicians this often would somebody would have said like you are not right, get to the hospital.

SPEAKER_01 15:07

And you know, like I think a lot of people who don't understand racing don't understand the stress that it puts on your body. Oh, yeah, it's yeah. It's it's I mean, you know, they're athletes.

SPEAKER_00 15:22

Yeah, they say they sweat like like the equivalent of you know, uh five marathons in one race.

SPEAKER_01 15:28

And just imagine driving 200 miles an hour for two hours straight. Two hours straight, and yeah. I'm having a tough time on the the snow for 15 minutes. Yeah. You know, so again, I mean, I think the the G forces on your body, they're they need the Tesla auto auto drive thing.

SPEAKER_00 15:49

You just hit a button, keep turning left, just keep turning left.

SPEAKER_01 15:53

At 200 miles an hour, I'm not sure.

SPEAKER_00 15:55

I don't know.

SPEAKER_01 15:55

I mean, but again, the stress on your body talking to you, Elon. You have to know when is when, right? And I think like for these athletes, Tiger, whoever, right? I'm not comparing them to Tiger, but you go, if you're a top-tier athlete, you push your body so hard. Yep, where is the where's the line? Where's the line? Where's the point that you're like, you know, I'm ninth in the cup standings right now. Memorial day weekend is ahead. I'm 41 years old, I've got a family, yeah, two kids, yeah. Where do you draw that line? I don't know. Um, but but again, the question I'll ask you is should this be a warning sign? Yeah, yeah, like you know what? Like, uh maybe this time I'm not gonna ignore that. Because ultimately, is it the sinus infection that that killed him? A bacteria infection? I mean, you should go to the doctor earlier.

SPEAKER_00 16:53

Yeah, yeah. Uh, and particularly so generally what we tell people is, you know, if you've got, let's say you've got what you think is a sinus infection, if it's not gone in about or improving in about 48 hours, it's time to see your physician. Now, they may get you in there and say, nah, it looks like a viral infection, treat it with some Tylenol and rest and that sort of stuff. But oftentimes they can tell whether they do a swab or whatever, like, hey, this is a this is a bacterial infection, you need some, you know, often we start with amoxicillin, like a penicillin-based based uh antibiotic, but they can tell what's going on, and at that, and at that point, um, you know, they're gonna give you they're gonna give you some antibiotics, and then uh, you know, typically that antibiotic treats it, but you still have to rest. I mean, there's still like it takes a toll on your body, you still have to rest, which I'm sure he was never gonna do, but rest. R-E-S-T. That's right. Sleep as medicine, man. Sleep as medicine. Started to do a lot more of that in my 40s. Yeah.

SPEAKER_01 17:54

Hey, I I used to push my body to the absolute limit of whatever it was, you know. And I've kind of learned that it's a your body needs that recovery. Your body needs that recovery to you know be as good or better tomorrow than it is today. Yeah. Um, because pushing it at 45 is different than 35 and 25. It is, it is a hundred percent different than pushing it at 35 and 25.

Practical Advice Sepsis Reality Check

SPEAKER_01 18:24

Um, so R.I.P. Kyle Busch, uh again, one of the greatest racers of all time.

SPEAKER_00 18:32

And um and it and we may do a different podcast on this one, but I think there's a lot of new things that come out with sepsis all the time. So I think there's some new treatments and some new medications and all that kind of stuff. I mean, the mainstay is the antibiotics and the fluids, but um, you know, it's nothing over the counter, nothing. No, no, no. It's uh at some point there was some descriptions of using steroids that maybe did or didn't work. Um, there were a couple of like um, you know, drugs that came out from a different couple different pharmaceutical companies that maybe helped, maybe didn't. Um, but I mean it's still, you know, sepsis is one of the hardest things to treat in the ICU, especially when you get to severe sepsis, and especially in older folks who aren't healthy. Obviously, you know, he was a he was a young, healthy guy. Um, the problem with him is probably that it it was so far gone by the time he got in. But yeah, sepsis continues to be one of the major killers of uh one of the major killers of of people who come into the hospital with infections.

SPEAKER_01 19:28

This has been going under anesthesia answered with Dr. Brian Schmutzler. I'm Vahid Sadrzadi. We are brought to you by The Butterfly Network. See you next time. Stole it from you.

SPEAKER_00 19:38

Always, man.