Suspected sepsis
A streamlined, differential-led presentation for rapid clinical review.
Twenty-second review
- Sepsis is life-threatening organ dysfunction from a dysregulated response to infection, involving vascular tone, capillary permeability, cellular metabolism, and tissue perfusion.
- Altered mentation, hypotension, tachypnea, hypoxia, mottling, oliguria, or rapidly worsening function with suspected infection requires urgent transport.
- Keep noninfectious sirs or metabolic illness in the differential; overlapping or concurrent illness remains possible.
- For suspected sepsis, trends and combinations of findings are more informative than one isolated vital sign.
Compare the clinical patterns
The repeated material is grouped inside each possibility. Open only the condition you need.
SepsisTime-sensitive high-risk possibility
HPI
Clarify suspected source; onset and infectious symptoms; mental status and perfusion.
Signs & symptoms
Infection plus organ dysfunction, poor perfusion, persistent hypotension, or rising severity.
Focused exam
Assess skin, hydration, respiratory findings, abdomen, urinary symptoms, wounds, lines, and mental status as relevant; Repeat temperature and perfusion observations; obtain collateral baseline information.
Brief pathophysiology
Sepsis may cause suspected sepsis through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
No single vital sign diagnoses sepsis. New tachypnea, abnormal temperature, tachycardia, or falling pressure—especially with altered mentation or poor perfusion—supports organ dysfunction and urgency.
Respiratory rate (breaths/min)
May rise earlyTachypnea is included in NEWS2 and can precede overt hypotension.
Temperature (°C)
High or lowAbsence of fever does not exclude sepsis; hypothermia is concerning.
Heart rate (bpm)
Often risesTachycardia is common but may be blunted by age or medication.
Blood pressure (mmHg)
May fallRelative hypotension and trend matter; profound hypotension can be late.
Front-load in the triage report
- Sepsis: Infection plus organ dysfunction, poor perfusion, persistent hypotension, or rising severity.
- Suspected source?
- Onset and infectious symptoms?
Septic shockTime-sensitive high-risk possibility
HPI
Clarify onset and infectious symptoms; mental status and perfusion; temperature and serial vitals.
Signs & symptoms
Infection plus organ dysfunction, poor perfusion, persistent hypotension, or rising severity.
Focused exam
Repeat temperature and perfusion observations; obtain collateral baseline information; Seek source in lungs, urine, abdomen, skin, wounds, and devices while assessing perfusion, hydration, mental status, and immune risk.
Brief pathophysiology
Septic shock may cause suspected sepsis through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
No single vital sign diagnoses sepsis. New tachypnea, abnormal temperature, tachycardia, or falling pressure—especially with altered mentation or poor perfusion—supports organ dysfunction and urgency.
Respiratory rate (breaths/min)
May rise earlyTachypnea is included in NEWS2 and can precede overt hypotension.
Temperature (°C)
High or lowAbsence of fever does not exclude sepsis; hypothermia is concerning.
Heart rate (bpm)
Often risesTachycardia is common but may be blunted by age or medication.
Blood pressure (mmHg)
May fallRelative hypotension and trend matter; profound hypotension can be late.
Front-load in the triage report
- Septic shock: Infection plus organ dysfunction, poor perfusion, persistent hypotension, or rising severity.
- Onset and infectious symptoms?
- Mental status and perfusion?
Localized infection with systemic responseCommon presentation pattern
HPI
Clarify suspected source; onset and infectious symptoms; mental status and perfusion.
Signs & symptoms
Fever, tachycardia, tachypnea, and source symptoms may be present.
Focused exam
Assess skin, hydration, respiratory findings, abdomen, urinary symptoms, wounds, lines, and mental status as relevant; Repeat temperature and perfusion observations; obtain collateral baseline information.
Brief pathophysiology
Localized infection with systemic response may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.
What the trend may show
No single vital sign diagnoses sepsis. New tachypnea, abnormal temperature, tachycardia, or falling pressure—especially with altered mentation or poor perfusion—supports organ dysfunction and urgency.
Respiratory rate (breaths/min)
May rise earlyTachypnea is included in NEWS2 and can precede overt hypotension.
Temperature (°C)
High or lowAbsence of fever does not exclude sepsis; hypothermia is concerning.
Heart rate (bpm)
Often risesTachycardia is common but may be blunted by age or medication.
Blood pressure (mmHg)
May fallRelative hypotension and trend matter; profound hypotension can be late.
Front-load in the triage report
- Fever, tachycardia, tachypnea, and source symptoms may be present.
- Suspected source?
- Onset and infectious symptoms?
Noninfectious SIRSImportant alternative presentation
HPI
Clarify suspected source; onset and infectious symptoms; mental status and perfusion.
Signs & symptoms
Trauma, pancreatitis, PE, or DKA can produce similar physiology.
Focused exam
Assess skin, hydration, respiratory findings, abdomen, urinary symptoms, wounds, lines, and mental status as relevant; Repeat temperature and perfusion observations; obtain collateral baseline information.
Brief pathophysiology
Noninfectious SIRS can resemble suspected sepsis through overlapping symptoms or referred physiology despite a different primary mechanism.
What the trend may show
No single vital sign diagnoses sepsis. New tachypnea, abnormal temperature, tachycardia, or falling pressure—especially with altered mentation or poor perfusion—supports organ dysfunction and urgency.
Respiratory rate (breaths/min)
May rise earlyTachypnea is included in NEWS2 and can precede overt hypotension.
Temperature (°C)
High or lowAbsence of fever does not exclude sepsis; hypothermia is concerning.
Heart rate (bpm)
Often risesTachycardia is common but may be blunted by age or medication.
Blood pressure (mmHg)
May fallRelative hypotension and trend matter; profound hypotension can be late.
Front-load in the triage report
- Trauma, pancreatitis, PE, or DKA can produce similar physiology.
- Suspected source?
- Onset and infectious symptoms?
Metabolic illnessImportant alternative presentation
HPI
Clarify onset and infectious symptoms; mental status and perfusion; temperature and serial vitals.
Signs & symptoms
Trauma, pancreatitis, PE, or DKA can produce similar physiology.
Focused exam
Repeat temperature and perfusion observations; obtain collateral baseline information; Seek source in lungs, urine, abdomen, skin, wounds, and devices while assessing perfusion, hydration, mental status, and immune risk.
Brief pathophysiology
Metabolic illness can resemble suspected sepsis through overlapping symptoms or referred physiology despite a different primary mechanism.
What the trend may show
No single vital sign diagnoses sepsis. New tachypnea, abnormal temperature, tachycardia, or falling pressure—especially with altered mentation or poor perfusion—supports organ dysfunction and urgency.
Respiratory rate (breaths/min)
May rise earlyTachypnea is included in NEWS2 and can precede overt hypotension.
Temperature (°C)
High or lowAbsence of fever does not exclude sepsis; hypothermia is concerning.
Heart rate (bpm)
Often risesTachycardia is common but may be blunted by age or medication.
Blood pressure (mmHg)
May fallRelative hypotension and trend matter; profound hypotension can be late.
Front-load in the triage report
- Trauma, pancreatitis, PE, or DKA can produce similar physiology.
- Onset and infectious symptoms?
- Mental status and perfusion?
Findings that should escalate concern
- Hypotension
- Altered mental status
- Respiratory distress
- Mottled or poorly perfused skin
- Altered mentation, hypotension, tachypnea, hypoxia, mottling, oliguria, or rapidly worsening function with suspected infection requires urgent transport.
- Sepsis or septic shock: Infection plus organ dysfunction, poor perfusion, persistent hypotension, or rising severity.
Medication recognition
Continue the clinical pathway
Clinical and academic sources
Curated clinical guidance and peer-reviewed evidence supporting this presentation. Current BCEHS guidance, medical direction, and local policy remain authoritative for practice.
BCEHS Handbook — specific CPGs
Supporting clinical and academic evidence
- CEDIS Presenting Complaint List updateCanadian Association of Emergency Physicians
Presenting-complaint terminology and categorization context. It does not establish a prehospital “top 100” ranking.
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026Society of Critical Care Medicine and European Society of Intensive Care Medicine
Contemporary sepsis physiology, perfusion, and hemodynamic context. Hospital treatment recommendations do not replace BCEHS guidance.
- Suspected sepsis in people aged 16 or over: recognition, assessment and early managementNational Institute for Health and Care Excellence
Recognition, early assessment, monitoring, risk, and limitations of isolated observations in suspected adult sepsis.
- Identification of adults with sepsis in the prehospital environment: a systematic reviewBMJ Open · 2016
Prehospital sepsis recognition, screening-tool limitations, organ dysfunction, and serial perfusion assessment.