What are the definitive signs of sepsis that Emergency Medical Services (EMS) personnel should be aware of?

Definitive Signs of Sepsis for EMS Personnel

EMS personnel should recognize sepsis through a combination of vital sign abnormalities (temperature >38.3°C or <36°C, heart rate >90 bpm, respiratory rate >20 bpm), altered mental status, and signs of infection, which indicate the need for urgent medical evaluation and transport. 1

Key Clinical Signs and Symptoms

Vital Sign Abnormalities

• Temperature abnormalities:
  • Fever >38.3°C (100.4°F) or
  • Hypothermia <36°C (96.8°F) 2, 1
• Cardiovascular changes:
  • Heart rate >90 beats per minute
  • Arterial hypotension (systolic BP <90 mmHg or decrease >40 mmHg from baseline)
  • Mottled or discolored skin
  • Decreased capillary refill 2, 1
• Respiratory changes:
  • Respiratory rate >20 breaths per minute
  • Rapid breathing or breathlessness
  • Difficulty breathing
  • Arterial hypoxemia (SpO2 ≤90%) 2, 1

Neurological Changes

• Altered mental status
• Confusion
• Slurred speech
• Dizziness 1

Other Important Signs

• Decreased urine output
• Severe muscle pain
• Feeling very unwell or sense of impending doom
• Nonblanching rash
• Clammy/sweaty skin 1
• Rigors/shivering 1

Signs of Organ Dysfunction (Severe Sepsis)

The presence of the following indicates progression to severe sepsis, requiring immediate intervention:

• Respiratory dysfunction: SpO2 ≤90%, central cyanosis, signs of respiratory distress 2
• Renal dysfunction: Acute oliguria (urine output ≤0.5 mL/kg/h) 2
• Hepatic dysfunction: Jaundice 2
• Coagulation dysfunction: Petechiae, ecchymoses, bleeding from puncture sites 2
• Gastrointestinal dysfunction: Ileus (absent bowel sounds) 2

High-Risk Populations

EMS personnel should maintain a higher index of suspicion for sepsis in:

• Immunocompromised patients, particularly those with neutropenia after chemotherapy 1
• Elderly patients
• Those with chronic medical conditions
• Patients with recent surgery or invasive procedures

Practical Assessment Approach for EMS

1. Initial Assessment: Check vital signs with particular attention to temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation
2. Mental Status: Assess for confusion, altered mental status, or changes from baseline
3. Skin Assessment: Look for mottling, poor capillary refill, rashes, or clammy skin
4. Source Identification: Look for obvious sources of infection (wounds, catheters, etc.)

Common Pitfalls in Sepsis Recognition

• Sepsis may present without fever, especially in elderly, immunocompromised, or hypothermic patients 2
• Relying solely on blood pressure can delay recognition, as hypotension is often a late sign 3
• Failure to recognize altered mental status as a key early indicator of sepsis 4
• Not considering sepsis in patients with vague symptoms like weakness or "feeling unwell" 4

EMS Actions

When sepsis is suspected:

• Provide high-flow oxygen if hypoxemic
• Establish IV access
• Consider fluid resuscitation if hypotensive
• Transport rapidly to appropriate facility
• Provide early notification to receiving facility about suspected sepsis 3

Research shows that paramedics can effectively identify sepsis in the field, though EMTs and FF-EMTs may benefit from additional education and training in sepsis recognition 5. Early recognition by EMS personnel can significantly impact patient outcomes by reducing time to appropriate treatment 3.