Not usually an issue unless the patient becomes unresponsive causing airway obstruction or if sepsis is related to infection of the throat or soft tissue of the neck.

Patients may present with:

• Hypoxia

  • The lung is involved early in the inflammation process. Fluids and proteins leak into interstitial tissues, causing swelling and decreased oxygen transfer across the alveoli. Due to reduced surfactant, lungs become stiffer.

• Raised respiratory rate – an early sign of sepsis

  • Shallow, quick breaths

  • Respiratory rate may increase in response to metabolic acidosis, and to meet the increased oxygen demands of organs, muscles and tissues. This may be more pronounced if infection is due to pneumonia

• On auscultation: crackles may be audible if patient has pneumonia or developing acute respiratory distress syndrome (ARDS).

Patient may present with:

• Tachycardia

• Hypotension

• Peripheral vasodilation – skin flushed and warm with normal capillary refill time (CRT)

• Or peripherally cool with delayed CRT (later sign)

  • Vasodilation and capillary leakage causes hypovolaemia and reduced vascular resistance leading to hypotension. Patients will try to compensate. Initially patients will feel warm peripherally and have a normal CRT. But as compensatory mechanisms fail patients will start to feel cold and shut down peripherally.

• Reduced urine output

  • Urine output is a good measure of cardiac output, if urine output is decreased it is likely that cardiac output has also fallen.

• Peripheral oedema

  • Due to leaky capillaries, patients may also become oedematous with fluid moving to the interstitial spaces.

May present drowsy, agitated or with new confusion

May present as hyperthermic, hypothermic or normothermic – do not let a normal temperature stop you thinking sepsis!!