Clinical Case Study: Recognising & Managing Sepsis
Sepsis is often called the “silent killer” — and for good reason. It can start quietly, masquerade as a simple infection, and escalate with terrifying speed. Recognising the subtle signs early, delivering the Sepsis Six within the critical first hour, and advocating clearly can literally be the difference between life and death. This is one skill you will use every single shift.
📋 How to Use This Case Study
- Read through Margaret’s background and bedside story carefully — this is your handover.
- Write down your answers to all 4 questions before clicking anything. What would you prioritise first? Who would you call?
- Click “Reveal Answer & Rationale” to compare your reasoning against evidence‑based practice.
Patient Background & Clinical Narrative
Patient: Margaret Bennett, 78 years old
Background: Admitted 24 hours ago with lower respiratory tract infection. History of COPD, hypertension, mild CKD. Normally chatty and sociable — was settling well on oral antibiotics.
What You See: Early shift 06:00. Margaret is turned away, slow to respond, confused — disoriented to time and person. Skin cold/clammy but says she feels burning hot inside. Breathing faster than last night. Urine output only 40 mL in 8 hours.
Assessment & Key Findings
- Respiratory Rate: 26 breaths/min
- SpO₂: 91% on room air
- BP: 88/52 mmHg — dropping
- Heart Rate: 122 bpm — tachycardic
- Temperature: 35.7°C — low, not high
- Capillary Refill: 4–5 seconds — delayed
- Conscious Level: Confused (AVPU: V)
- Urine Output: 40 mL / 8 hrs — oliguria
NEWS2 Score: 9 — High Risk → Immediate Response Required
Question 1: Not Always a Fever — Hypothermia as a Red Flag
Margaret’s temperature is 35.7°C — below normal. Why is a low temperature alongside confusion and hypotension just as dangerous — and sometimes more so — in older patients?
Answer: Older/vulnerable patients often cannot mount a fever response. Hypothermia + confusion + tachycardia + hypotension = the body’s systems starting to fail — a late but critical sepsis marker.
Rationale: Sepsis = life‑threatening organ dysfunction from dysregulated infection response. In elderly people, immune systems may not produce high temperatures. Instead, confusion, cold skin, and reduced urine output are the clearest red flags. By the time temperature drops, homeostasis is failing — this is a medical emergency.
Question 2: The Sepsis Six — Within One Hour
You suspect sepsis. List the six interventions that must be completed within the first hour — in priority order.
Answer: The Sepsis Six — deliver within 60 minutes of recognition:
- Give high‑flow oxygen if saturations below target
- Take blood cultures — before antibiotics
- Give IV antibiotics — as soon as prescribed
- Give IV fluid resuscitation — bolus as directed
- Measure lactate — above 2 mmol/L = tissue shock
- Measure hourly urine output — catheterise if needed
Rationale: Every hour of delay increases mortality by ~8%. Cultures before antibiotics = accurate targeting. Lactate tells you how severely organs are starved of oxygen.
Guidance: NICE NG51 — Sepsis: Recognition, Diagnosis & Early Management.
Question 3: Escalation — SBAR Handover
Call the team now. Deliver your urgent SBAR — use the word “sepsis” to signal priority.
Key point: Say the word “sepsis” — it triggers priority protocols. If they don’t come quickly, escalate again. You are her advocate.
Question 4: Compassion in Crisis
Margaret is frightened, asking for her husband who passed away three years ago. The team is rushing. How do you keep her safe and calm?
Answer: Assign one person to stay with her. Speak gently, explain every action, reassure her, hold her hand. Do not leave her alone.
Rationale: Confusion + fear = spiking heart rate and oxygen demand — which makes her condition worse. A calm voice and steady presence are not “extras” — they are essential care. Even if she can’t fully understand, she will feel safer knowing someone is there.
Guidance: NICE Delirium Guideline & NMC Code — Promoting wellbeing and person‑centred care.