A fictional 54-year-old presents with fever, new confusion, low blood pressure and reduced urine output after two days of urinary symptoms.
Frame the danger first.
- Ask whether infection could be causing organ dysfunction or an abnormal physiological response.
- Use NEWS2 in adults in an acute hospital, while also applying clinical judgement.
- Consider communication difficulty, immunosuppression and recent treatment that may mask typical features.
Act, escalate, reassess.
- Escalate according to the patient’s risk category and current NICE/local sepsis pathway.
- Assess for a source, obtain appropriate samples and arrange investigations without avoidable delay.
- Start time-critical treatment using current local antimicrobial and medicines guidance.
- Reassess response, organ function and whether source control or critical-care input is required.
Red flags that change pace.
- High-risk sepsis criteria, shock or rapidly worsening observations
- Reduced consciousness, mottled or ashen appearance, or markedly reduced urine output
- Concern about source control, immunosuppression or treatment failure
What makes care less safe.
- Using a score as a substitute for clinical judgement
- Delaying escalation while awaiting a test result
- Anchoring on infection and overlooking haemorrhage, pulmonary embolism or another mimic
Say the concern plainly.
I am concerned about suspected sepsis with [organ dysfunction/high-risk feature]. The likely source is [known/uncertain]. The current response and outstanding actions are [brief list]. I need senior review now and a decision about [source control/critical care/diagnostic uncertainty].