Suspect sepsis with a known or suspected infection plus altered mentation, fast breathing or low blood pressure.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A septic patient remains at 78/42 with clear lungs after an adequate crystalloid volume. What is the preferred next vasoactive agent?
Answer: A. Septic shock is distributive: vessels are dilated and leaky, so after adequate fluid a vasoconstrictor restores tone, and norepinephrine is the first-line vasopressor in current sepsis guidelines. Calcium channel blockers and nitrates further lower pressure, and a beta-2 agonist causes vasodilation rather than restoring tone.
Question 2 of 5
An 84-year-old nursing-home resident is newly confused, breathing 26 times a minute, has a blood pressure of 94/58 and a temperature of 96.4 °F. What should you suspect?
Answer: A. Older adults and immunocompromised patients frequently mount no fever and may be hypothermic in sepsis; new confusion, tachypnea and low blood pressure together are the classic screening picture. Hypothermia in sepsis signals a worse prognosis. Assuming dementia or dehydration because there is no fever is how sepsis is missed in older patients.
Question 3 of 5
A patient with a known kidney stone has flank pain, a temperature of 102.6 °F, rigors and a heart rate of 122. Why is this more urgent than an ordinary kidney stone?
Answer: A. An obstructing stone with fever suggests infected urine trapped behind the blockage, which can progress to urosepsis and shock quickly and needs urgent drainage. Treat as sepsis: assess perfusion, IV access, fluid for hypotension and early notification. Pain does not cause fever, and a stone passing into the bladder usually relieves symptoms rather than worsening them.
Question 4 of 5
Which patient presentation is most consistent with sepsis?
Answer: A. Sepsis is infection plus organ dysfunction, and in older patients confusion is often the first organ to declare it, alongside the tachycardia of a failing circulation. Fever alone in a well patient is infection without dysfunction, exertional chest pain is cardiac, and a cough with normal vitals is uncomplicated.
Question 5 of 5
A septic patient with a history of heart failure is hypotensive. After the first isotonic bolus, his blood pressure improves slightly and new crackles appear at both bases. What is the best next step?
Answer: A. Fluid for sepsis is given in boluses with reassessment after each one; new crackles mean the heart cannot handle more volume and further fluid will cause pulmonary edema. Stop, position upright and escalate for vasopressor support. Continuing a fixed volume regardless of response is the error, and new bilateral crackles after fluid should not be dismissed as pneumonia.
Keep the streak going with more questions like these, each with a full rationale.
What is sepsis & septic shock?
EMS impact comes from recognizing it early, starting fluids, and alerting the receiving facility so antibiotics are not delayed.
Key points to remember
- Suspect sepsis with a known or suspected infection plus altered mentation, fast breathing or low blood pressure.
- Fever is not required — older adults and immunocompromised patients may be normal or cold.
- Low end-tidal CO2 in suspected infection suggests poor perfusion and elevated lactate.
- Early crystalloid fluids are indicated for hypotension or poor perfusion; reassess lungs between boluses.
- Vasopressors are for hypotension that persists after adequate fluid resuscitation.
Field priorities
- Notify the receiving facility early with a sepsis alert.
- Obtain vascular access and start fluids for hypotension or signs of poor perfusion.
- Check glucose and support oxygenation; watch for crackles during fluid resuscitation.
Coaching the patient
- Warm, flushed skin can occur early in septic shock because the vessels dilate — do not let warm skin reassure you.
Red flags: act now
- Hypotension persisting after fluids
- New confusion with infection
- Mottled skin or very low end-tidal CO2
Sepsis & Septic Shock: FAQs
What are the priority actions for Sepsis & Septic Shock in the field?
Notify the receiving facility early with a sepsis alert. Obtain vascular access and start fluids for hypotension or signs of poor perfusion. Check glucose and support oxygenation; watch for crackles during fluid resuscitation.
What findings in Sepsis & Septic Shock change your plan or your transport decision?
Hypotension persisting after fluids. New confusion with infection. Mottled skin or very low end-tidal CO2.
What do I need to know about Sepsis & Septic Shock for the NREMT?
Suspect sepsis with a known or suspected infection plus altered mentation, fast breathing or low blood pressure. Fever is not required — older adults and immunocompromised patients may be normal or cold. Low end-tidal CO2 in suspected infection suggests poor perfusion and elevated lactate. Early crystalloid fluids are indicated for hypotension or poor perfusion; reassess lungs between boluses.
What should the crew communicate or document for Sepsis & Septic Shock?
Warm, flushed skin can occur early in septic shock because the vessels dilate — do not let warm skin reassure you.
