How to recognise sepsis and septic shock before it becomes fatal — including the key warning signs, who is most at risk, and what to say to emergency services.
Septic shock kills tens of thousands of people in the UK each year and hundreds of thousands globally. It is one of the most preventable causes of death in developed medical systems — but prevention depends on early recognition, which frequently fails because sepsis mimics other common conditions and its early signs are easy to miss or attribute to the underlying infection.
Septic shock is the most severe form of sepsis: a state where the body's response to infection has caused circulatory failure, with blood pressure dropping to levels that cannot sustain organ function. In septic shock, every hour of delay in hospital treatment increases mortality.
Sepsis is not the infection itself — it is the body's dysregulated, overwhelming immune response to infection. In sepsis:
Any infection can cause sepsis, but some are more commonly associated:
| Group | Risk Factor |
|---|---|
| Over 75 years old | Immune function reduced; common infections more severe |
| Diabetics | Infection risk and immune response impaired |
| Immunosuppressed (cancer, chemotherapy, steroids, HIV) | Reduced ability to contain infection |
| Recently hospitalised or post-surgery | Exposure to hospital-acquired organisms |
| Pregnant women | Physiological changes affect immune response |
| Very young children | Immune system not fully mature |
| People with chronic conditions (kidney, liver, lung disease) | Organs less resilient to septic insult |
Sepsis is often called "septicaemia" colloquially. The clinical signs can be grouped into the SEPSIS mnemonic used in UK public health campaigns:
| Letter | Sign |
|---|---|
| S | Slurred speech or confusion |
| E | Extreme shivering or muscle pain |
| P | Passing no urine in a day |
| S | Severe breathlessness |
| I | It feels like you might die |
| S | Skin mottled, discoloured, or very pale |
⚠️ The phrase "it feels like you might die" is clinically significant — it appears in major sepsis guidance because a subjective sense of extreme illness, reported by the patient or observed by those around them, is a reliable indicator of severe sepsis. Take it seriously.
| Sign | Description |
|---|---|
| Very high temperature (>38.5°C / 101.3°F) | Fever indicating severe infection |
| Very low temperature (<36°C / 96.8°F) | Hypothermia in sepsis — more serious than fever |
| Rapid heart rate (>100 beats per minute at rest) | Compensatory tachycardia |
| Rapid breathing (>20 breaths per minute) | Respiratory compensation |
| Low blood pressure | Particularly significant in known baseline hypertension |
| Reduced responsiveness | Confusion, drowsiness, or unconsciousness |
| Non-blanching rash | Flat red or purple spots that do not fade when a glass is pressed against them — indicates meningococcal disease or DIC; emergency |
If a non-blanching rash is present (press a clear glass against the skin — the rash does not fade under pressure), call 999 immediately. This is a sign of meningococcal septicaemia or disseminated intravascular coagulation — both are rapidly fatal emergencies.
Call 999 if you or anyone around you has any of the SEPSIS signs above, particularly:
When calling, say the word "sepsis" — this triggers immediate triage protocols in UK emergency services. Do not just say "they have a bad infection" — say "I think this might be sepsis."
There is no first aid intervention that treats sepsis in the field. The correct response while waiting for emergency services:
Septic shock requires a bundle of treatments to be administered within one hour of diagnosis (the "sepsis 6"):
Early antibiotics within one hour of sepsis recognition is associated with significantly reduced mortality. Every hour of delay increases mortality by approximately 7% in septic shock.
| Condition | How It Differs From Sepsis |
|---|---|
| Flu | Sepsis usually has a clear source of infection; flu less organ involvement; use SEPSIS signs |
| UTI without sepsis | Localised symptoms; no systemic signs; responds to oral antibiotics |
| Heart attack | Different signs predominate; chest pain, radiation to arm |
| Pulmonary embolism | Sudden breathlessness, chest pain, may have leg swelling |
| Dehydration | Responds to oral or IV fluid; no high fever, no organ failure |
If uncertain — use the SEPSIS mnemonic. If any of those signs are present, call 999.
| Sign | Action |
|---|---|
| Any SEPSIS signs | Call 999; say "I think this is sepsis" |
| Non-blanching rash | Call 999 immediately — meningococcal emergency |
| Confused + infection | Call 999 — do not wait to see if it improves |
| Paracetamol for high fever | Do not give without medical advice |
| Keeping warm | Yes — sepsis causes heat loss |
| Food and water | No — patient may need surgery |
| If unconscious | Recovery position; CPR if not breathing |
| Say this to 999 | "I think this might be sepsis" |
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