A 71-year-old man on the surgical ward, day two after anterior resection, triggers a NEWS2 score of 8: temperature 38.6°C, heart rate 122/min, BP 92/58 mmHg, respiratory rate 26/min, new confusion. The ward doctor suspects sepsis. Which initial management bundle should be completed, and within what timeframe?
- AThe Sepsis Six within one hour: oxygen, cultures, antibiotics, fluid, serial lactates and urine output, with senior review
- BBlood cultures, intravenous fluids and broad-spectrum antibiotics, all completed within 24 hours of the NEWS2 trigger firing
- CAwait the CRP result before any antibiotics
- DGive antibiotics only once CT has identified the source of sepsis
- EParacetamol and reassessment on the next ward round
Show answer and explanation
Correct answer: A
He has sepsis with features of septic shock evolving — new organ dysfunction (confusion, hypotension) in the context of presumed infection after anastomotic surgery. The Sepsis Six operationalises the first hour: three things given (oxygen titrated to target saturations, broad-spectrum intravenous antibiotics after cultures, intravenous crystalloid), three things taken or measured (blood cultures, lactate — repeated to track clearance — and urine output monitoring, usually via catheter). Every hour of delay to effective antibiotics in septic shock measurably increases mortality, which is why antibiotics precede confirmation of a source but follow cultures where this causes no delay. Equally surgical: the bundle is the beginning, not the end — a post-operative septic patient needs senior review and an urgent search for a source amenable to control (this man needs a CT abdomen for an anastomotic leak, as antibiotics cannot sterilise undrained contamination), plus escalation to critical care if hypotension persists after fluid.
Why the others are wrong: B — 24 hours is a mortality statistic, not a timeframe; the bundle is an hour. C — CRP neither confirms nor excludes sepsis and never gates treatment. D — imaging follows resuscitation and antibiotics; treatment is not withheld pending localisation. E — antipyretics and a routine round review are the anatomy of a preventable arrest call.
Key point: Suspected sepsis with organ dysfunction triggers the Sepsis Six within one hour — oxygen, cultures, antibiotics, fluid, lactate, urine output — with senior review and urgent source-control assessment alongside; in the post-operative patient, find and drain the source.
Guidelines: UK Sepsis Trust Sepsis Six and NICE sepsis guidance: high NEWS2 with suspected infection triggers the hour-one bundle — oxygen, cultures, broad-spectrum antibiotics, fluids, lactate and urine-output monitoring — plus urgent senior surgical review for source control.