Symptoms are generally nonspecific and secondary to primary infection. They include fever, leukocytosis, tachypnea, and pulse >90 bpm.
Sepsis can progress rapidly to multiorgan failure and shock, and is often fatal. Survival is dependent on a high index of suspicion of sepsis, early recognition, and immediate intervention.
Patients with any evidence of organ dysfunction require immediate hospital assessment.
Empiric broad-spectrum antibiotic therapy (based on the most probable pathogens) should be administered as soon as possible, and always within the first hour following recognition.
Culture of all wounds or potentially infected body fluids should be performed, as indicated by symptoms, before initiation of antimicrobial treatment if possible.
Any source of infection should be controlled as a matter of urgency, preferably within 6 hours following recognition.
Evidence of hypoperfusion or shock should be sought and treated with immediate intravenous fluid challenges, if present. Shock that fails to respond to fluid challenges necessitates urgent critical care referral for consideration of early "goal-directed therapy" (antibiotics, fluid resuscitation, vasopressors, or inotropes).
Severe purpura fulminans, most commonly associated with pneumococcal septicemia
From the personal collection of Ron Daniels, MB, ChB, FRCA