The septic patient
Learn to recognise and treat sepsis, step by step. Spotting the sick patient early, delivering the first-hour bundle, and finding the source. Built for revision, not live patient decisions.
Settle them, and check the basics
the clock starts nowRed flags — what each should make you think
Sepsis is a time-critical diagnosis, like a heart attack or a stroke. The single biggest thing you can do is start the Sepsis Six within the first hour — and don't let a normal temperature reassure you, the elderly and immunocompromised can be septic without a fever.
The Sepsis Six — within the first hour
- O₂Give oxygentitrate to target saturations
- cxTake blood culturesbefore antibiotics — but don't delay them for it
- ℞Give IV antibioticsbroad-spectrum, per local policy
- IVGive IV fluidsa balanced crystalloid bolus, reassess
- lacCheck lactatea marker of severity and perfusion
- UOMeasure urine outputcatheter to track the response
Understand the patient & find the source
where is the infection?Hunt the source — it changes everything
- Chest — cough, sputum, focal signs → pneumonia
- Urine — dysuria, loin pain → pyelonephritis / urosepsis
- Abdomen — pain, peritonism → intra-abdominal / biliary
- Skin / soft tissue — cellulitis, wounds, lines
- CNS — headache, neck stiffness, rash → meningitis
Always ask: are they immunocompromised or neutropenic (chemotherapy, steroids)? That escalates the urgency and changes the antibiotics.
Work A–E — assess and act as you go
The forms you must not miss
tap to open eachWhat points toward it, what would rule it in, and how to manage it.
Sepsis with hypotension persisting after fluids, or a lactate above 2 mmol/L.
Ongoing hypotension needing vasopressors to maintain the blood pressure, with a raised lactate.
Escalate urgently — senior + critical care. Vasopressors, ongoing resuscitation, source control. This is an ITU-level problem.
Fever or feeling unwell in someone on chemotherapy or otherwise immunocompromised.
Neutrophils low, but don't wait for the count — treat empirically.
Immediate broad-spectrum IV antibiotics per local neutropenic-sepsis policy, cultures, senior/oncology. Minutes matter.
Fever with a non-blanching (petechial or purpuric) rash, often with headache or neck stiffness.
Clinical — treat immediately, don't wait for confirmation.
Immediate IV ceftriaxone (benzylpenicillin in the community before transfer), resuscitate, senior help.
Severe pain out of proportion to the skin appearance, rapidly spreading, systemically very unwell, sometimes crepitus.
A surgical diagnosis — imaging must not delay theatre.
Urgent surgical review for debridement, broad-spectrum antibiotics, aggressive resuscitation.
Source control is half the treatment
Antibiotics won't win alone if there's a collection, an obstructed kidney, an infected line or dead tissue. Finding and controlling the source — drainage, removal, surgery — is as important as the first-hour bundle.
Investigate — what to order, when, and what it tells you
test with a question in mindLactate (VBG)
Blood cultures & screen
Find the source
Track the response
How the plan comes together
disposition · handoverward
Responding well to the bundle, lactate clearing, stable observations, clear source and plan.
Safety-net: clear escalation triggers, repeat obs, antibiotic review.
escalate / ITU
Shock, high or rising lactate, poor fluid response, or organ dysfunction → critical care early.
Hand over: source, Sepsis Six timings, lactate trend, response to fluids.
Reassess after the bundle. Sepsis that isn't responding to fluids and antibiotics needs a senior and critical care now, not another hour of watching. Nicely done getting here.