Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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High-risk suspected sepsis
Suspected infection with high-risk physiology, organ dysfunction, neutropenia or rapidly progressive source can cause death within hours. Palliative care status must not delay emergency treatment when reversal and escalation remain consistent with the person's wishes.
Action: Use ABCDE care, calculate NEWS2, check glucose and lactate, obtain cultures and blood tests without delaying antibiotics and give source-appropriate intravenous antimicrobial treatment within the current NICE timeframe. Use reassessed 250 mL crystalloid boluses for hypoperfusion and involve senior, critical-care and source-control teams while confirming ceilings and capacity.
Synopsis
Recognise sepsis and other reversible deterioration without labelling every change as dying, assess urgency and treatment goals in parallel and use antibiotics, fluids, source control or a time-limited trial when benefit remains proportionate.
Palliative status does not exclude reversible illness. New confusion, hypotension, tachypnoea, hypoxia, reduced urine, rigors or functional collapse requires active assessment rather than automatic attribution to dying.
Sepsis is life-threatening organ dysfunction from infection; fever may be absent in older, neutropenic, corticosteroid-treated or dying patients.
First-line assessment combines ABCDE, NEWS2, infection source, perfusion, cognition, urine output, medicines and baseline trajectory with immediate review of the person's goals.
Key red flags
New confusion, reduced consciousness or a sudden major functional fall can be organ dysfunction even without fever.
High-risk sepsis
NICE high-risk criteria, marked lactate elevation, severe hypotension, respiratory failure or rapidly progressive infection requires emergency treatment and senior review.
Investigation priorities
01
ABCDE, NEWS2 and bedside glucoseFirst step
Quantify immediate airway, breathing, circulation, cognition and temperature risk and identify hypoglycaemia as a rapid alternative.
Management branches
High-risk sepsisTreat physiology and source immediately
Suspected infection meets current NICE high-risk criteria or causes rapidly progressive organ dysfunction.
Use ABCDE and NEWS2, obtain lactate, cultures and organ bloods, call senior help and confirm any known escalation limits without delaying rescue.
Give source-appropriate intravenous antibiotics within the emergency timeframe and 250 mL reassessed crystalloid boluses for hypoperfusion when safe.
Key medicines
Empiric intravenous antimicrobial for high-risk sepsisGive the source-specific local broad-spectrum regimen within the NICE emergency timeframe, using allergy, previous microbiology, healthcare exposure, weight and renal and hepatic function to select and dose treatment.
Reassessed isotonic crystalloid bolusFor sepsis-related hypoperfusion in an adult, give 250 mL isotonic crystalloid over about 10 to 15 minutes and reassess before each further bolus, using the current NICE maximum and senior review.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.