Sepsis / Septic Shock

Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. NG253 (2025) stratifies by NEWS2: NEWS2 ≥7 is high risk, 5–6 moderate, 1–4 low. This app teaches antibiotics within 1 hour for high AND moderate risk…

NICE NG253 — NEWS2 risk-stratified

The pathway

1 · Recognise and score

Calculate NEWS2 — the clock for antibiotics runs from when you calculate it
≥7 HIGH · 5–6 MODERATE · 1–4 LOW
qSOFA is not the NICE screen — it predicts mortality in people already known to be infected
Clinical concern overrides the score

2 · Re-score if high risk

Recalculate NEWS2 every 30 minutes while high risk
People move between categories — usually down in the first hour if treatment is working, and up if it is not

3 · Give O₂

Target SpO₂ 94–98%, or 88–92% if at risk of hypercapnic failure
15L NRB if critically unwell, then titrate down

4 · Take blood cultures

Two sets peripherally before antibiotics
Do not delay antibiotics >45 minutes for them

5 · Give IV antibiotics

HIGH (NEWS2 ≥7): broad-spectrum within 1 hour of scoring. Do not wait for a source
MODERATE (5–6): aim for 1 hour too, having made a real attempt to find the source and target the choice
Deliberately tighter than NICE: NG253 allows up to 3 hours at moderate risk. A three-hour window is easy to lose to one crash bleep. Follow your trust if it differs
Follow local antimicrobial policy for the drug

6 · Give IV fluids

250ml balanced crystalloid (Hartmann's) over 10–15 min
Reassess after every bolus — the step people skip
Further 250ml boluses up to 1000ml, then senior review
30ml/kg is Surviving Sepsis (US), not UK — in an 80kg adult that is 2.4L

7 · Check lactate

>2 is evidence of organ hypoperfusion — it raises the risk category
It is not the definition of sepsis, and >4 is not septic shock
Septic shock = vasopressors to keep MAP ≥65 AND lactate >2 despite fluids
A normal lactate does not exclude sepsis
Repeat at 1–2 hours

8 · Measure urine output

Catheterise
Target >0.5ml/kg/hr
Hourly monitoring

9 · Reassess at 1 hour

Not improving: escalate to registrar or ITU
Consider vasopressors (noradrenaline — ITU only)

Drugs

Drug	Dose	Route	Notes
Piperacillin-tazobactam	4.5g	IV	Q8h. An EXAMPLE of broad-spectrum cover for an unknown source — your local antimicrobial policy is the operative instruction, not this line. Adjust in renal impairment.
Co-amoxiclav	1.2g	IV	Alternative for community-acquired infections per local policy.
Gentamicin	5mg/kg	IV	Once daily. Check levels. Avoid in AKI unless essential.
Hartmann's / 0.9% NaCl	250ml over 10–15 min	IV	Balanced crystalloid preferred. Reassess after each bolus. Up to 1000ml before senior review.

When to escalate

Lactate >2 mmol/L that does not clear after fluid resuscitation,SBP <90 or MAP <65 despite 1000ml of fluid — senior review, likely vasopressors,Organ dysfunction: creatinine >2x baseline, bilirubin rising, platelets falling,No improvement at 1 hour,Requires vasopressors,Moderate risk with no source found, or deteriorating — senior review, do not let the hour slip

Reference: NICE NG253 Suspected sepsis in people aged 16 or over (2025, replaced NG51), with ONE DELIBERATE DEVIATION: this app teaches a 1-hour antibiotic target at moderate risk where NG253 permits up to 3 hours — see the antibiotics step. The 30ml/kg figure widely taught comes from the Surviving Sepsis Campaign (US/international) and is not UK guidance.

This page is the reference half

The app adds what a web page cannot: a VINDICATE differential builder, worked on-call scenarios with full A–E findings, recall practice, and all of it offline.