Sepsis Recognition: The Unwell Patient with Infection
How to tell when a patient presenting with infection may be developing sepsis, and when to seek urgent medical help without delay.
Why this matters
Sepsis is a major cause of preventable death and serious illness in the UK. It is not an infection itself but a life-threatening condition in which the body's response to infection begins to damage its own tissues and organs. Community pharmacists are often the first healthcare contact for someone who feels unwell with an infection, and the opportunity to recognise deterioration early can be critical.
The challenge is that sepsis can initially resemble a routine infection. A patient who appears mildly feverish or tired may be deteriorating, and waiting to see whether they improve is not always safe. Community pharmacists do not need to diagnose sepsis. The role is to recognise when a patient with infection appears significantly unwell, identify red flags, and arrange urgent medical assessment.
Red flags vs more likely benign
| Feature | More likely benign | Red flag ⚠ |
|---|---|---|
| Temperature | Mild fever with otherwise reassuring features | Very high or abnormally low temperature, especially alongside other signs of serious illness |
| Heart rate | Mild increase during illness | Markedly fast heartbeat or patient reports a pounding heart |
| Breathing | Normal rate and effort | Fast, laboured, shallow breathing, or difficulty speaking in full sentences |
| Mental state | Alert and orientated | New confusion, drowsiness, agitation, unusual behaviour, or reduced responsiveness |
| Skin appearance | Warm and well perfused | Mottled, pale, blue-tinged, cold, or clammy skin |
| Urine output | Normal | Passing much less urine than usual, or no urine for a prolonged period |
| Overall appearance | Unwell but communicating and functioning | Appears seriously unwell or is deteriorating rapidly |
| Rash | None, or blanching viral rash | Non-blanching rash anywhere on the body |
If observations are available
Abnormal observations can support concern for sepsis. Particular concern should be raised by:
- Respiratory rate above 20 breaths per minute
- Oxygen saturation below 95% on air
- Systolic blood pressure below 100 mmHg
- Pulse rate above 90 to 100 beats per minute
- Temperature above 38°C or below 36°C
- New confusion, drowsiness, or reduced responsiveness
The presence of multiple abnormal observations in a patient with suspected infection should prompt urgent escalation. NEWS2 may support assessment where used locally, but should never replace clinical judgement. A patient who appears significantly unwell should be escalated even if observations are not markedly abnormal.
What to do in pharmacy
Key takeaways
- Community pharmacists do not need to diagnose sepsis. The priority is recognising when a patient with infection appears seriously unwell and arranging urgent assessment.
- Confusion, rapid breathing, mottled or pale skin, reduced urine output, or a non-blanching rash alongside infection are important warning signs.
- Abnormal observations such as low oxygen saturation, low blood pressure, tachycardia, abnormal temperature, or a raised respiratory rate should increase concern, but should never override clinical judgement.
- Older adults, immunocompromised patients, pregnant women, and people with poorly controlled diabetes may deteriorate more rapidly and should be assessed promptly even when symptoms initially appear mild.