Sepsis is a life-threatening reaction to infection. The body’s immune system overreacts causing damage to tissues and organs. It has a high risk of mortality and is a common cause of patient deterioration in the inpatient setting.

Septic shock is a subset of sepsis where the circulatory and cellular/metabolic dysfunction is associated with a higher mortality. In a patient who has been adequately fluid resuscitated, it is defined as the presence of:

• Persistent hypotension requiring vasopressors to maintain MAP greater than or equal to 65 mm Hg, and/or

• Lactate ≥ 2 mmol/L

National early warning score and sepsis

It is a national recommendation to screen for sepsis using the National Early Warning Score. When a patient has a NEWS 5 or above or a single RED score >3, we should consider sepsis. However, not all patients with a raised NEWS will have sepsis so it is important that we rule out other causes of deterioration. Patients with suspected sepsis will need close monitoring.

Be aware of patients who are at a higher risk of developing sepsis:

• The immunocompromised (this may be due to medication or disease)

• The very young (neonates)

• The elderly

• Woman who are pregnant or have given birth, miscarried or had a termination of pregnancy in the last 6 weeks.

Common sources of infection: