My most recent septic patient had literally zero SIRS criteria, and I strongly did not suspect a bacterial source of infection. Isolated hypotension, nothing else. Said she felt great and asked to go home To date she's grown out GPCs on 8/10 blood cultures. Sepsis actually is hard. Also, it sounds like a bacterial source was not suspected in this case (and was validated by the cultures being negative and the autopsy), so AFAICT this was not sepsis.

> Also, it sounds like a bacterial source was not suspected in this case (and was validated by the cultures being negative and the autopsy), so AFAICT this was not sepsis.

Am confused by this. Sepsis can be a response to bacterial, viral, or fungal infection, no?

It's not that obvious...

Let's do a chronological analysis of some prior definitions of sepsis.

The first one, from the 1990s, utilized an elevated white blood cell count plus three clinical variables (temperature, heart rate, and respiratory rate). This definition is very broad; statistically speaking, it's very sensitive but has low specificity.

The most recent definition describes sepsis as 'life-threatening organ dysfunction caused by a dysregulated host response to infection.' Septic shock is defined as a subset of sepsis in patients who have a vasopressor requirement and a lactate level greater than 2 mmol/L.

Scores such as NEWS, SOFA, and qSOFA exist, but they primarily assess disease severity and prognosis for patients who are already in a hospital setting.

It is very important to always maintain a high degree of suspicion for sepsis, but it seems to me that few clinicians would have had a strong suspicion of it in this case...

You're right, and I should be more specific - what I referred to was things like SIRS, SOFA, and qSOFA (which was being introduced at the BLS level around here in 2022) for "suspicion scores".

But even then:

> but it seems to me that few clinicians would have had a strong suspicion of it in this case...

Tachycardic, febrile and with a suspected infection?

The issue here seemed to me to be two-fold, misdiagnosis of a viral infection versus bacterial, but in the setting of treating for a bacterial infection to then be consciously overlooking multiple markers for sepsis?

I 100% get where you are coming from; however, in the ER setting, multiple non life threatening conditions could cause these symptoms (I assume paramedics don't get as much experience in in-hospital settings, please correct me if I am wrong as I am not from the US!)

That said, there was a cascade of errors that ultimately led to this very very unfortunate outcome (that maybe could have been prevented, or maybe not)

Had the chest x-ray been ordered perhaps his enlarged heart could have been noticed in due time.

I do not mean to be pretentious in any way. I hope my english does not interfere with this.

You're absolutely fine! Definitely a lot other things can also have those influences on temperature, HR. Our EMS system started teaching SIRS (and then qSOFA) to EMS providers to have them tell the charge nurse that the patient "meets Sepsis criteria", because this was being missed in triage and septic patients were spending hours on hours waiting for care.

Paramedics don't get very much in-hospital time here, other than getting intubation experience in the OR with an anesthesiologist.

I appreciate your input, it does not come across at all pretentious - and as a paramedic, I would never want to "not learn more medicine".