ABCs
- Check vitals and random blood glucose
- Recheck temperature → oral/axillary vs tympanic discrepancies
- Assess for deterioration: hypotension, tachypnea, desaturation, confusion
- If in shock, call for assistance and escalate
HPI
- Onset, duration and pattern
- Fever details: new/persistent, trend, method used
- Any focal source of infection
- Sick contact or food ingestion
- Review the chart:
- Being treated for an infection?
- Already on antibiotics?
- Length of admission?
- Risk factors or previous growth of MRSA/Pseudomonas?
- Immunocompromised?
- Doses are adjusted according to cultures and renal function
- Review the last 24 hours: surgery, line insertion, new meds, ICU transfer
| System | Key Features |
|---|---|
| CNS | Headache, confusion, seizures, nausea/vomiting, photophobia, neck stiffness |
| ENT | Purulent ear discharge, sinus tenderness, mastoid pain |
| Cardiac | Pleuritic chest pain (better leaning forward), new murmur |
| Respiratory | Cough, dyspnea, hemoptysis, chest pain, aspiration risk, ventilator changes |
| Gastrointestinal | Abdominal pain, bowel changes, nausea, vomiting |
| Skin / Soft Tissue | Cellulitis, ulcers, pressure sores, cannula or surgical sites |
| Rheum / MSK | Joint swelling or pain, rash, myalgia, bone pain |
| GU | Dysuria, hematuria, frequency, flank pain |
| Gyne | Vaginal discharge, pelvic pain |
| Devices | Pacemaker, PEG, Foley, central line, tracheostomy sites |
examination
- tailored to flagged systems
- don’t forget
- joint assessment
- cannula/wound inspection
- chest and heart auscultation
- surgical site palpation
workup
- Review available investigations
- Leukocytosis or neutropenia
- CRP or PCT trends
- Previous cultures
- Any recent viral swabs
- Chest X-ray findings
- If stable:
- CBC with diff, CRP ± PCT
- Trace pending cultures, viral swabs
- CXR
- Monitor trends
- If new, unwell, or worsening → full septic screen:
- CBC, CRP, PCT, LFT, RFT, lactic acid
- Urinalysis + culture
- Stool culture ± C. diff
- Blood cultures x2 (different sites)
- Sputum culture ± ETT aspirate
- Wound/ulcer swab
- Line tip culture if removed
- Soft tissue ultrasound (if needed)
- CXR
- Consider surgical referral (e.g., diabetic foot, ulcers)
management
- Clinically stable and investigated
- Reassess pending results
- Give paracetamol 1 g IV q6h (Max 4 g/day less in liver disease)
- If new-onset, unwell, or deteriorating
- Send cultures first (if safe)
- Start empiric antibiotics early
- Adjust dose for renal function
- Antibiotic Selection → consider
- Site of infection
- Severity
- Immune status
- Prior cultures/resistance
- Local resistance patterns
- Risk of MRSA or Pseudomonas
- Consider Microbiology / ID consult if complex
- If Called About Positive Cultures
- Check if on the appropriate antibiotic
- Review organism sensitivities
- Adjust antibiotic choice accordingly
- Repeat CBC and CRP to assess response
- Consider Micro / ID consult if needed
- Review dose and duration
See also: MOC+ Volume 1: Acute Infections — covers sepsis, source identification and empirical antibiotics in depth.
Studying for R1? The IM Rapid Review covers this in the same format — see the sample chapter.
Last reviewed · May 2026