GP · emergency-medicine
Sepsis recognition and escalation from primary care
Also known as Sepsis · Septic shock · Bacterial infection emergency
GP-fellowship guide to sepsis recognition and escalation from primary care: Sepsis-3 definitions and what infection plus organ dysfunction means at the bedside, qSOFA's limits as a screening tool, NEWS2 escalation thresholds, red flags that demand same-hour action, the hour-1 bundle with cultures before antibiotics where possible without delay, balanced crystalloid resuscitation, source-directed antibiotics, ISBAR ambulance handover, and post-sepsis follow-up.
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Red flags
- Sepsis can present WITHOUT fever — hypothermia, confusion or a systolic BP of 95 in an elderly patient is septic shock until proven otherwise; waiting for fever costs lives
- A normal early lactate does not exclude sepsis — repeat it if suspicion stands; lactate above 2 mmol/L marks hypoperfusion, above 4 mmol/L marks high mortality risk
- Every hour of delayed antibiotics raises mortality by roughly 4% (OR 1.04 per hour) — give the first dose before transfer when IV access exists
- qSOFA is a prompt to look closer, not a screening rule — a negative qSOFA never excludes sepsis
Overview
Sepsis begins as an infection that looks ordinary and turns lethal through the body's own response.[1] In general practice it hides inside urinary infections, chest infections, cellulitis and belly pain — and its first hour decides much of its outcome. Sepsis-3 defined it precisely: life-threatening organ dysfunction from a dysregulated host response to infection, operationalised as an infection plus a SOFA increase of two points or more, carrying about 10% in-hospital mortality.[1] Septic shock adds vasopressor dependence and lactate above 2 mmol/L after fluids, with mortality above 40% in the derivation cohorts.[1]
References7ShowHide
- [1]Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA, 2016.PMID 26903338
- [2]Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA, 2016.PMID 26903335
- [3]Seymour CW, Gesten F, Prescott HC, et al. Time to Treatment and Mortality during Mandated Emergency Care for Sepsis N Engl J Med, 2017.PMID 28528569
- [4]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021 Crit Care Med, 2021.PMID 34605781
- [5]Rudd KE, Seymour CW, Aluisio AR, et al. Association of the Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) Score With Excess Hospital Mortality in Adults With Suspected Infection in Low- and Middle-Income Countries JAMA, 2018.PMID 29800114
- [6]Brown RM, Wang L, Coston TD, et al. Balanced Crystalloids versus Saline in Sepsis. A Secondary Analysis of the SMART Clinical Trial Am J Respir Crit Care Med, 2019.PMID 31454263
- [7]Melero-Guijarro L, Sanz-García A, Martín-Rodríguez F, et al. Prehospital qSOFA, mSOFA, and NEWS2 performance for sepsis prediction: A prospective, multi-center, cohort study Front Med (Lausanne), 2023.PMID 37144037