Sepsis (Adults)


Sepsis SIRS + suspected infection
Severe Sepsis Sepsis + organ failure/evidence of tissue hypoperfusion
Septic Shock Severe sepsis + hypotension (fall by >40mmHg from patient’s normal) despite fluid resuscitation

SIRS (caused by sepsis, burns, trauma and pancreatitis) with 2 or more criteria
Temperature >38 or <36
Tachypnoea >20 or PaCO2 <4.3 kPa
Heart rate >90
Hyperglycaemia in the absence of diabetes mellitus
Altered mental state
Leukocytosis/Leukopenia <4 or >12(x10 9/L)
Normal WBC with >10% immature forms


Can be non-specific or poorly localised symptoms such as feeling unwell with a normal temperature


Age >65 years
Does the patient have underlying chronic disease? Alcoholism, diabetes, indwelling lines/catheters, pregnancy, malignancy?
Is there any reason for the patient to have impaired immunity? Immunosuppressant therapy, HIV/AIDS?
Has the patient had any recent (last 6 weeks) surgeries or invasive procedures?
Has the patient had any recent trauma to the skin?
Has the patient had any history of intravenous drug use?
Has the patient been passing urine?

Examination Findings

Poor capillary refill time, mottled skin
Altered mental state
Signs related to source of infection (e.g. offensive smelling urine for signs on a urinary tract infection)
Skin rashes e.g. purpura fulminans

Vital Signs

Temperature of >38 or <36
Low oxygen saturations
Hypotensive (indicates end-organ dysfunction)

The aim of investigations is to identify the causative organism and source of infection and assess for end organ dysfunction

Bedside tests

ABG/VBG – to ascertain patients lactate

Laboratory Investigations

Blood cultures
Other cultures e.g. would site swab, urine etc
FBC – looking at WBC for leucocytosis or leukopenia
U+Es – urea and creatinine may be elevated, electrolytes should be measured regularly until the patient improves
Coagulation studies (INR, PTT)

Radiological Investigations

Echocardiogram – if suspected bacterial endocarditis
Ultrasound scan – usually abdominal to help locate source of infection
CT chest/abdomen – if clinically indicated to establish source of infection e.g. suspected deep abscess

Special Investigations

Lumbar puncture – suspected meningitis

Management of sepsis of unknown origin

Sepsis Six all to be done within the golden hour (within one hour of the diagnosis)
1. Achieve oxygen saturations of >94% with high flow oxygen
2. Take blood cultures (and establish IV access)
3. Give IV broad spectrum antibiotics (if no clear source give tazocin 4.5g TDS + vancomycin (1g/12 hours IV) for MRSA + gentamicin (5mg/kg OD) or use local guidelines) be cautious in renal railure
4. Measure serum lactate
5. Start IV fluid resuscitation
6. Monitor hourly urine output

Consider referral to intensive care
If source of infection is known, alter investigations and antibiotics as per hospital protocol



Renal dysfunction
Acute respiratory distress syndrome
Disseminated intravascular coagulation
Multiple organ system failure


Neurological complications


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