OSCE — Sepsis & Septic Shock · MBBS OSCE

Brief (to candidate)

You will assess a patient with a presentation consistent with Sepsis & Septic Shock.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.^[1]

Clinical context

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection (Sepsis-3 definition, Singer 2016). Operationally it is identified at the bedside as an acute change in total SOFA score of 2 or more points consequent to infection. Septic shock is a subset of sepsis with circulatory and cellular/metabolic abnormalities substantial enough to substantially increase mortality — clinically hypotension requiring vasopressors to maintain a mean arterial pressure of at least 65 mmHg AND a serum lactate over 2 mmol/L despite adequate volume resuscitation, carrying a hospital mortality over 40 percent. Common sources are respiratory, abdominal, urinary, skin/soft tissue.^[1]

Candidate tasks

Clarify onset, severity, associated features, and red-flag symptoms.
State focused examination priorities.
List first-line investigations and any named score/criteria.
Give immediate resuscitation steps.
Outline definitive management with doses/routes where standard.
Name complications and disposition (ward / HDU / theatre / discharge safety-net).
Mention one special-population modifier (pregnancy, child, elderly, CKD).^[1]^[2]

Examiner checklist

Domain	Pass behaviours
Definition	Correct working diagnosis language
Assessment	Focused, prioritised, red flags sought
Investigations	Appropriate first-line + interpretation
Emergency care	ABC / time-critical actions first
Definitive care	Specific drugs/procedures, not generic phrases
Safety	qSOFA ≥2 is a prompt, not the sole screen
Safety	Sepsis-3 shock: vasopressors for MAP ≥65 AND lactate >2 mmol/L
Safety	≥30 mL/kg crystalloid in 3 h for hypoperfusion or shock; norepinephrine first-line
Communication	Clear plan and safety-netting

Model outline

Lead with Sepsis-3 language (SOFA increase ≥2; shock = vasopressors for MAP ≥65 and lactate >2). Resuscitate with SSC 2021: antimicrobials immediately in shock; ≥30 mL/kg crystalloid in 3 h for hypoperfusion or shock (not a lactate-4 trigger); norepinephrine first-line. Never delay antimicrobials for imaging.^[1]^[2]

References2Show

[1]Singer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA, 2016.PMID 26903338
[2]Evans L, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 Intensive Care Med, 2021.PMID 34599691

Clinical context

Candidate tasks

Clarify onset, severity, associated features, and red-flag symptoms.

State focused examination priorities.

List first-line investigations and any named score/criteria.

Give immediate resuscitation steps.

Outline definitive management with doses/routes where standard.

Name complications and disposition (ward / HDU / theatre / discharge safety-net).

Mention one special-population modifier (pregnancy, child, elderly, CKD).^[1]^[2]

Examiner checklist

Domain	Pass behaviours
Definition	Correct working diagnosis language
Assessment	Focused, prioritised, red flags sought
Investigations	Appropriate first-line + interpretation
Emergency care	ABC / time-critical actions first
Definitive care	Specific drugs/procedures, not generic phrases
Safety	qSOFA ≥2 is a prompt, not the sole screen
Safety	Sepsis-3 shock: vasopressors for MAP ≥65 AND lactate >2 mmol/L
Safety	≥30 mL/kg crystalloid in 3 h for hypoperfusion or shock; norepinephrine first-line
Communication	Clear plan and safety-netting

Model outline

References2Show

[1]Singer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA, 2016.PMID 26903338
[2]Evans L, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 Intensive Care Med, 2021.PMID 34599691