Synopsis
Recognise infection-associated acute organ dysfunction early, distinguish immediate physiological danger from lower-risk infection, and connect bedside findings to time-critical investigation, treatment and repeated reassessment.
- Sepsis is life-threatening organ dysfunction caused by a dysregulated response to infection; fever and a positive culture are neither necessary nor sufficient for the diagnosis.
- Begin with ABCDE, observations, NEWS2 and clinical trajectory. A normal temperature, modest inflammatory markers or apparently reassuring blood pressure does not exclude dangerous deterioration.
- Look deliberately for new confusion, increased oxygen requirement, tachypnoea, hypotension, poor peripheral perfusion, reduced urine output, non-blanching rash and inability to maintain normal activity.
Key red flags
New hypotension, marked tachypnoea, increased oxygen need, altered mental state, mottled or ashen skin, cyanosis, non-blanching rash or very low urine output indicates threatened organ function and demands immediate senior assessment.
Investigation priorities
Quantify physiological disturbance, find hypoglycaemia and establish a repeatable baseline.
Management branches
Suspected infection plus NICE high-risk criteria, shock, rapidly worsening organ dysfunction or strong clinician concern.
- Call senior help, perform ABCDE, secure monitoring and intravenous access, measure lactate and obtain cultures and source samples without delaying treatment.
- Give oxygen only when needed, use small reassessed crystalloid boluses for hypoperfusion, and administer source-appropriate broad-spectrum intravenous antimicrobials within the nationally recommended high-risk timeframe.
Key medicines
Balanced isotonic crystalloidGive 250 mL intravenously over 10 to 15 minutes, then reassess before any repeat bolus.