Recognizing and escalating possible sepsis

Sepsis occurs when the body’s response to infection becomes harmful and causes organ dysfunction. It is a medical emergency, not simply another word for fever or infection. Septic shock is a severe form involving dangerous circulatory problems. A person needs urgent professional assessment; a care worker’s concern does not need to become a confirmed diagnosis before escalation.

Use precise language in a handover: describe what changed, what infection is known or suspected, and why urgent help is needed. Avoid labelling every infection as sepsis, but do not let uncertainty become a reason to postpone help. An awareness course teaches recognition and communication, not the clinical judgement needed to diagnose organ dysfunction.

Fictional exercise: a colleague says that a resident’s infection was already reported yesterday, so today’s deterioration can wait. Explain why a new change requires a new response. Identify the new facts you would convey and the emergency route you would use, without inventing a diagnosis or assuming that yesterday’s plan remains sufficient.

Practice: Write a two-sentence explanation of sepsis for a colleague, then a separate urgent handover for the fictional deterioration.

Bacterial infection commonly causes sepsis, but viral, fungal and other infections can also be involved. Possible starting points include the lungs, urinary tract, skin and abdomen. The clinical team investigates the source and chooses treatment. A worker should not decide that sepsis is impossible because the exact organism or infection site is unknown.

Collect relevant facts already available: a recent infection, wound change, symptoms, procedures and treatment history. Separate these from guesses. Infection prevention, recommended vaccination and timely assessment of infections reduce risk, but following precautions does not guarantee that a person cannot deteriorate. Continue the appropriate infection-control measures during assistance.

Fictional comparison: one handover says “probably just the same infection”; another gives the known treatment history and the new change since the previous shift. Rewrite the first using only supplied facts. Leave unknown information marked unknown rather than spending time searching for a complete story before calling for help.

Practice: Create a fictional handover with three columns: confirmed infection information, new observations and unanswered questions.

Warning signs can include a high or low temperature, confusion, breathing difficulty, very fast pulse, low blood pressure, severe discomfort, clammy skin and reduced urine. No single sign proves sepsis, and the absence of fever does not provide reassurance when someone is deteriorating. Compare current observations with the person’s usual state and report the timing of changes.

In children, concerning changes may include unusually fast breathing, seizures, pallor, marked drowsiness or difficulty waking. Babies and young children may feed poorly, vomit repeatedly or pass much less urine. These are reasons for urgent assessment, not a checklist that must be completed before help is sought. Adult assessment thresholds must not be applied to children.

Fictional exercise: a caregiver says a child is unusually difficult to wake and is not feeding normally. Practise communicating the exact change and requesting immediate help. Do not dismiss the caregiver’s concern because the child cannot describe symptoms. In a second scenario, record an adult’s new confusion without describing it as their usual behaviour unless that is actually known.

Practice: Practise one adult and one child emergency handover. Include onset and change from baseline, and state what you have not measured.

Anyone with an infection can develop sepsis. Higher-risk groups include older adults, newborns, people who are pregnant or recently pregnant, people with impaired immunity and those with some chronic illnesses. Hospitalized people are also vulnerable. In children, infancy, immune problems and cancer treatment are important background information to communicate.

Risk factors inform vigilance; they do not diagnose sepsis or rule it out in a previously healthy person. Avoid ranking a person as safe solely because they are young or have no recorded medical conditions. Likewise, a person’s disability or age must not be used to explain away a new change. Check relevant information respectfully and share it with the responding clinical team.

Fictional exercise: compare two people with a new serious change, one receiving cancer treatment and one with no known long-term condition. Both need an appropriate urgent response. Explain which additional background information you would give for the first person, and why the second person still needs help. Do not invent a numerical risk score from this lesson.

Practice: List the relevant background facts in the fictional cases and explain why absence of a known risk factor cannot cancel an urgent concern.

For suspected sepsis with serious deterioration, activate the setting’s emergency response immediately; in the community call 911. State that you are concerned about possible sepsis, describe the change and give the location. Do not substitute a routine message, next-shift handover or non-emergency advice line for emergency help. Remain with the person when safe and follow the responder’s instructions.

Give the onset, known or suspected infection, relevant conditions, allergies, medicines and actual observations. Record measurements only if trained and able to obtain them without delaying assistance. Use the current locally approved, age-appropriate screening tool within your role; an adult hospital protocol is not a universal Canadian or paediatric tool. A score must not override a serious clinical concern. If the first contact is unavailable, use the emergency escalation route.

Clinicians may investigate infection and organ function and provide antimicrobials, intravenous fluids and organ support. This lesson does not authorize those interventions. Note the time help was requested, who responded and the instructions received; continue to report further deterioration. Fictional drill: practise a 30-second call, check that the receiver understands the urgency and explain your next action if there is no response.

Practice: Use your setting’s emergency contact procedure to rehearse the fictional call without making a real call. Have an educator review the sequence and the clarity of your handover.