Sepsis Red Flags & The Sepsis Six Pathway
Sepsis kills over 48,000 people in the UK every year. A patient can slip from “unwell” to life-threatening in hours. Recognise the signs, start the 1-hour bundle, escalate fast — your speed saves lives.
“Think: Could this be sepsis? Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Every hour of delay in IV antibiotics increases mortality by nearly 8%.” — UK Sepsis Trust & NICE NG51 Guidance
1. Sepsis vs. Infection — Know the Difference
An infection stays in one place — a chest infection, UTI, or wound. Sepsis happens when the body’s immune system overreacts and spreads damage through the whole bloodstream. Blood vessels widen, organs don’t get enough oxygen, and everything can fail fast.
When blood pressure drops so low that fluids can’t fix it, that is Septic Shock — critical, high mortality, zero time to wait.
2. The Red Flags — NICE NG51 & UK Sepsis Trust
Watch your NEWS2 score. If it hits 5 or more, or any single observation scores a 3 — stop and check for Red Flag Sepsis immediately.
🚨 RED FLAG SEPSIS — ANY ONE = ACT NOW
- Respirations: 25+ breaths/min OR new oxygen need
- Blood Pressure: 90 systolic or lower — OR a 40+ drop from their normal
- Heart Rate: 130+ beats/min
- Confusion: New drowsiness, muddle, or drop in consciousness
- Urine: None in 18 hours — OR less than 0.5mL/kg/hr
- Skin: Mottled, blue-tinged, pale, or non-blanching rash
- Lactate: 2.0 mmol/L or higher on blood gas
3. The Sepsis Six — All Within 60 Minutes
Red Flag Sepsis = start the clock. Three tests to take, three treatments to give. Every single one matters.
⏱️ THE 1-HOUR BUNDLE
📥 TAKE 3 — DIAGNOSE FIRST
- Blood Cultures: Two sets — before antibiotics. If you give them first, you may never find the bug.
- Blood Lactate: Via ABG or VBG. 2.0+ means serious tissue shock — repeat after fluids.
- Urine Output: Catheter if needed. Target: 0.5mL/kg/hr minimum.
📤 GIVE 3 — TREAT FAST
- Oxygen: High-flow via non-rebreathe mask. Target 94–98% (88–92% if known COPD).
- Antibiotics: IV — exactly as per trust policy. Don’t delay waiting for cultures — they’re already taken.
- Fluids: 500mL crystalloid (Hartmann’s or 0.9% saline) over 15 minutes if BP low or lactate high. Reassess straight after.
4. Escalate With Confidence — SBAR Script
When you call the doctor, CCOT, or senior nurse — be clear, be direct, be heard. Here is exactly what to say:
5. If Help Doesn’t Come — Your Duty to Persist
Red Flag Sepsis is not something to wait and see about. If 15–20 minutes pass and no one has attended:
- Tell your Ward Sister or Charge Nurse immediately — they have the authority to escalate with you.
- Call the Critical Care Outreach Team (CCOT) directly — they exist for exactly this situation.
- If they are crashing — BP dropping, losing consciousness — dial 2222 and call the emergency response.
- Write everything down — who you called, when, and what they said. Accurate notes protect you and your patient.
Written by: Daniel Hancock, Registered Nurse
Focus: Sepsis recognition, Sepsis Six, acute deterioration, escalation
Published: September 2026 | Last reviewed: September 2026
For: UK student nurses — supervised learning only
⚠️ Cross-reference with NICE NG51, UK Sepsis Trust guidance, and your trust’s local Sepsis Six protocol. This guide supports — not replaces — urgent senior review and medical leadership. If in doubt — escalate.