Sepsis recognition and escalation from primary care — KFP-style written assessment

KFP 1 (10 marks)

An 82-year-old man has two days of urinary frequency. His wife found him confused this morning. BP 95/60 mmHg supine, RR 24/min, temperature 36.4 °C, oxygen saturation 93%. He lives at home with his wife. ^[1]

1. What is your working diagnosis and which findings establish it? (3) ^[1]
2. List your immediate actions in order. (4) ^{[3] [4]}
3. What does his normal temperature teach about sepsis recognition in the elderly? (3) ^[1]

Model answers

1. Sepsis with hypoperfusion (septic shock territory): suspected urinary source plus organ dysfunction — altered mentation, hypotension, tachypnoea. Sepsis-3 defines sepsis as life-threatening organ dysfunction from a dysregulated host response to infection; his clinical picture meets it without any laboratory confirmation. ^[1]
2. Oxygen if saturations fall; two large-bore IV cannulae; blood cultures plus urine culture before antibiotics where possible without delay; broad-spectrum IV antibiotics within one hour of recognition (each hour of delay carries OR 1.04 for mortality); balanced crystalloid at least 30 mL/kg over 3 hours; lactate if obtainable; ambulance with pre-alert and ISBAR handover stating times of antibiotics and fluids. ^{[3] [4]}
3. Fever is often absent in elderly sepsis — hypothermia, confusion, falls and functional decline are the presentation. Waiting for fever delays antibiotics; the diagnosis rests on infection plus organ dysfunction, not temperature. ^[1]