Sepsis & The Sepsis Six Pathway
Sepsis is a medical emergency. The body’s immune system turns against itself — and every minute lost matters. Know the signs. Know the Six. Act now.
From infection to organ damage — what’s happening inside, how to spot it early, and the one-hour life-saving bundle that changes outcomes.
When Infection Becomes Sepsis
Sepsis is life-threatening organ dysfunction caused by the body’s own immune response spiralling out of control. It isn’t just a bad infection — it’s the body over-reacting, causing widespread inflammation, leaky blood vessels, tiny clots blocking capillaries, and organs beginning to fail.
- Blood vessels leak: Fluid shifts out of the circulation — blood pressure drops, organs don’t get enough flow.
- Micro-clots form: Tiny blockages cut off oxygen to kidneys, liver, brain, heart.
- Cells can’t use oxygen: Metabolism fails, lactic acid builds up — the higher the lactate, the sicker the patient.
Sepsis can present with a low temperature — below 36°C — just as often as a high one. Confusion, drowsiness, slurred speech, or just “not right” — these are often the earliest signs. NEWS2 score rising? Don’t ignore it. Trust your gut.
The Sepsis Six — All Within 60 Minutes
The UK Sepsis Trust’s bundle — proven to save lives when completed within the Golden Hour. Memorise this list — you will use it.
Give High-Flow Oxygen
Target 94–98% (88–92% if known COPD). Correct hypoxia immediately — every organ is starved of oxygen already.
Take Blood Cultures
Two sets — one from each site — before antibiotics. Don’t delay antibiotics waiting for them, but don’t skip them either. They tell us exactly which bug we’re fighting.
Give IV Antibiotics
Broad-spectrum, according to local trust guidelines. Within the hour. Delay = higher mortality. That’s the evidence.
Start IV Fluid Resuscitation
500ml–1000ml crystalloid (Hartmann’s / Plasma-Lyte) fast. Restore the circulating volume. Re-check blood pressure — did it respond?
Check Lactate & Repeat
Lactate above 2 mmol/L = serious compromise. Above 4 = critical. Re-check in 2–4 hours — falling lactate means resuscitation is working.
Measure Urine Output Hourly
Catheterise if needed. Target: >0.5 mL/kg/hour. The kidneys are one of the first organs to suffer — if they’re not making urine, resuscitation isn’t enough.
Antibiotics — Start Broad, Narrow Early
We give broad-spectrum antibiotics in the emergency phase to cover everything. Once culture results come back — usually 24–48 hours — we switch to the targeted drug. That’s stewardship — protecting antibiotics for everyone, and reducing side effects like C. diff.
Your role: check doses aren’t delayed, watch for rashes or diarrhoea, and ask daily — “can this patient take tablets now?” IV-to-oral switch speeds recovery and reduces complications.
📖 Trusted Guidelines & References
Standards to cite and share — updated and current:
- NICE NG51 — Sepsis (replaced by NG253/NG254/NG255, March 2024) — Superseded but still widely referenced; current guidance split into adult, child, and pregnancy pathways.
- UK Sepsis Trust — The origin of the Sepsis Six; recognition tools, training, and latest research.
- Surviving Sepsis Campaign — International consensus guidelines and resuscitation bundles.
Written by: Daniel Hancock, Registered Nurse
Focus: Sepsis recognition, time-critical care, ward escalation
Published: September 2026 | Last reviewed: September 2026
For: UK student nurses — supervised learning only
⚠️ NICE NG51 has been replaced by NG253 (adults 16+), NG254 (children), and NG255 (pregnancy/recent pregnancy — all March 2024). Always follow your trust’s current pathway and escalate immediately if you suspect sepsis.