Recognising septic shock in the emergency department

Presentation

A 54-year-old previously well woman gives a 12-hour history of rigors, dysuria, and right flank pain. She looks unwell: respiratory rate 28/min, heart rate 118/min, blood pressure 84/50 mmHg, temperature 39.1 °C, and oxygen saturation 95% on room air. Her skin is warm and flushed, with a capillary refill of three seconds. The triage nurse has flagged her as possible sepsis and asks whether she needs the resuscitation bay now.^[3]

The answer is yes, immediately, and the reasoning must be articulated: she has a presumed infection, organ dysfunction is already present (tachypnoea, hypotension, altered perfusion), and the constellation is sepsis progressing toward septic shock.^[1]