Sepsis often begins with symptoms that may seem minor at first. Its early signs can look just like a routine infection, which is exactly what makes this life-threatening emergency so dangerous. In everyday clinical practice, sepsis is still too often recognized too late. Here, we’ll look at the warning signs that matter most and the five steps that can make all the difference in an emergency.

Tip 1: Question Nonspecific Complaints

Some patients present with seemingly trivial symptoms. They may report, for example, severe weakness, a general feeling of illness, chills, shortness of breath, drowsiness, new-onset confusion, severe pain, or circulatory problems. Older adults, in particular, can be seriously ill without developing a high fever.

This makes it more important to be vigilant in cases of acute infections when the patient appears significantly sicker than the supposedly harmless infection would suggest. Warning signs include tachypnea, hypotension, altered consciousness, cold or mottled skin, cyanosis, oliguria, syncope, or a rapid deterioration in general condition. The Surviving Sepsis Campaign Guidelines emphasized how crucial early recognition and prompt action are for the prognosis.

Tip 2: Identify High-Risk Patients Early

Not every patient with an infection is at the same risk for a severe course of the disease. Those at particularly high risk include older and frail individuals, as well as nursing home residents. Patients with diabetes, renal insufficiency, liver disease, chronic obstructive pulmonary disease, cancer, or immunosuppression also have an increased risk.

Other factors include recent surgery, catheters, wounds, or recurrent infections. For these patients, the threshold for a thorough physical examination, a complete assessment of vital signs, and, if necessary, admission to a hospital should be set correspondingly lower.

Tip 3: Record Vital Signs Comprehensively

If a significant infection is suspected, it is not sufficient to measure only temperature and blood pressure. Basic diagnostics include pulse, blood pressure, respiratory rate, oxygen saturation, temperature, and level of consciousness.

Respiratory rate deserves special attention, as it is easily underestimated in everyday practice. A respiratory rate of at least 22/min is a warning sign and one of the three criteria of the quick Sequential Organ Failure Assessment (qSOFA) score.

The qSOFA includes:

• Respiratory rate ≥ 22/min
• Systolic blood pressure ≤ 100 mm Hg
• Altered level of consciousness

If at least two of these criteria are met, the patient is at increased risk.

However, it is important to note that scores can support clinical assessment but cannot replace it. Studies show that early warning scores such as the National Early Warning Score 2 can sometimes be more sensitive than qSOFA in acute care settings.

Tip 4: Trust Your Clinical Judgment — and Act

Not every case of sepsis can be identified based on a single measurement. Often, the overall clinical impression is decisive. If a patient appears unusually seriously ill, noticeably pale, or drowsy, or if they suddenly behave differently than usual, this should be taken seriously. The same applies when family members say, “This isn’t like him.”

Such a gut feeling is by no means unprofessional. It is often based on clinical experience and the perception of subtle changes that are not immediately reflected in a single measurement.

Tip 5: Admit Early — Don’t Wait and See

If sepsis is suspected, waiting and seeing is not a good strategy. Rapid hospital admission is crucial, ideally with advance notification by phone. During the handoff, all relevant information should be conveyed concisely: suspected site of infection, onset and progression of symptoms, vital signs, level of consciousness, relevant preexisting conditions, immunosuppression, allergies, long-term medications, and medications already administered.

Why is time such a critical factor? Studies and meta-analyses show that earlier antibiotic therapy for sepsis is associated with lower mortality — particularly in critically ill patients and those experiencing septic shock.

In clinical practice, this does not mean rushing to prescribe antibiotics for every infection. Rather, the goal is to refer patients with a well-founded suspicion of sepsis without unnecessary delay to a care setting where further diagnostic testing and treatment can be performed promptly. This includes, among other things, blood cultures, lactate measurement, fluid therapy, and judicious antibiotic administration.

Conclusion

Sepsis is easily overlooked in everyday clinical practice because it can initially present as a common infection. This makes it more important to be alert to warning signs, consistently monitor vital signs, and pay special attention to high-risk patients.

When infection occurs alongside a markedly worsened general condition and abnormal vital signs, the threshold for hospital admission should be low. If sepsis is suspected, time should not be lost.

This story was translated from Medscape's German edition.