FFinalistSouthampton · 2027
Acute care
AKT · Acute care/Resuscitation & shock

Sepsis & septic shock

Dysregulated host response to infection → organ dysfunction

Overview

Life-threatening organ dysfunction from a dysregulated response to infection; septic shock is sepsis with persisting hypotension needing vasopressors + raised lactate despite fluids. Early recognition and the Sepsis Six save lives.

Recognise

  • Source of infection + systemic features (fever or hypothermia, tachycardia, tachypnoea, confusion)
  • Organ dysfunction: hypotension, oliguria, raised lactate, hypoxia, altered mentation
  • Septic shock: vasopressor-dependent hypotension + lactate >2 despite fluids

Red flags

  • Lactate >2, systolic BP <90 / MAP <65, reduced GCS, mottling, anuria → escalate to critical care

Differentials & how to tell them apart

Anaphylaxisacute trigger, urticaria/angioedema, no infective source
Hypovolaemic/haemorrhagic shockbleeding/fluid-loss history, no infection
Cardiogenic shockpump failure — raised JVP, pulmonary oedema, cardiac history
DKA/other metabolicketones, glucose — but sepsis can coexist/precipitate

Investigations

Use the Sepsis Six and NEWS2. Bloods incl. lactate, cultures (before antibiotics if no delay), FBC/CRP/U&E/clotting, ABG; identify and image the source.

Management

Sepsis Six within 1 hour: O2, cultures, IV antibiotics, IV fluids, lactate, urine output

  1. 1Sepsis Six within 1 hour — Give: high-flow O2, IV broad-spectrum antibiotics, IV fluid bolus. Take: blood cultures, lactate, urine output (catheter).Gate: Hypotension/lactate >2 persisting AFTER fluids = septic shock → noradrenaline + critical care
  2. 2Source control (drain abscess, remove infected line); de-escalate antibiotics on cultures.
Broad-spectrum IV antibiotics — per local policy, within 1 hour ("Sepsis Six")
IV crystalloid bolus — e.g. 500 mL boluses, reassess
Vasopressors (noradrenaline) — septic shock not responding to fluids — critical care

Key points

"Give 3, Take 3." Antibiotics within the hour. Lactate is the key severity/perfusion marker; rising lactate despite fluids signals shock.

Monitor & prognosis

Serial lactate, NEWS2, urine output, MAP; antibiotic review at 48–72h.

Mortality rises with every hour of delayed antibiotics.

Source: NICE NG51; UK Sepsis Trust (Sepsis Six)