Expansion
Find the source, then the severity, then the risk factors
Expansion
Common sources, examined deliberately
- Respiratory: cough, sputum, chest signs
- Urinary: dysuria, loin pain, catheter
- Abdominal: pain, tenderness, jaundice, diarrhoea
- Skin and soft tissue: cellulitis, wounds, pressure sores, look at the back and the feet
- Lines and devices: cannulae, central lines, catheters, pacemakers, prostheses
- Central nervous system: headache, neck stiffness, rash, confusion
- Joints: a hot swollen joint is septic arthritis until proven otherwise
- Endocarditis: murmur, peripheral stigmata, in anyone with a prosthetic valve or injecting drug use
Septic screen: blood cultures before antibiotics and from two sites, full blood count, C reactive protein, urea and electrolytes, liver function, lactate, urine culture, chest radiograph, and then sputum, stool, wound, cerebrospinal fluid or joint aspirate as directed.
Special situations
- Neutropenic sepsis in anyone within 6 weeks of chemotherapy; treat immediately
- Recent travel, so malaria films
- Immunosuppression, including steroids, biologics and HIV
- Post-operative fever, whose classic timeline runs wind (atelectasis, day 1 to 2), water (urine, day 3 to 5), wound (day 5 to 7), walking (venous thromboembolism, day 5 and beyond) and wonder drugs
- Non-infective causes: venous thromboembolism, drug fever, transfusion reaction, malignancy, connective tissue disease, thyroid storm
Hypothermia in an infected patient is as sinister as fever, and more so in the elderly, where sepsis frequently presents with confusion and a normal temperature.