Sepsis is life-threatening organ dysfunction caused by the body's dysregulated response to an infection. Treatment started within the first hour saves lives, and septic shock adds low blood pressure that does not respond to fluids alone.
Key symptoms
- Fever or chills, sometimes a low temperature
- Confusion, drowsiness or acting unlike themselves
- Fast breathing and shortness of breath
- Little or no urine
- Symptoms of the source: cough, painful urination, abdominal pain, red skin
What you find on exam
- Fast heart rate and fast breathing
- Low blood pressure; mean arterial pressure under 65 mm Hg
- Mottled or cold skin, slow capillary refill
- Altered mental status
- Search for the source: lungs, urine, abdomen, skin, lines
Tests
- Lactate; above 2 mmol/L suggests poor perfusion
- Blood cultures before antibiotics, ideally two sets
- Blood count, kidney and liver function, coagulation tests
- Urinalysis, chest X-ray and other imaging to find the source
Treatment basics
- Broad-spectrum IV antibiotics within 1 hour
- IV crystalloid 30 mL/kg for low blood pressure or lactate of 4 mmol/L or more
- Norepinephrine if blood pressure stays low after fluids
- Control the source: drain an abscess, remove an infected line
- Reassess often: vital signs, urine output, repeat lactate
Red flags
- Low blood pressure despite fluids
- New confusion or falling level of consciousness
- Rising lactate or very little urine
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; NASEMSO National Model EMS Clinical Guidelines. Written by Making Synapses. Making Synapses is not affiliated with these organizations.