Clinical Case Database / Category: Patient Management

Triage in the Emergency Department: Sepsis

Publication details

TE Kaier, CB Narshi
Foundation Years Journal, volume 7, issue 2, p.53 (123Doc Education, London, February 2013)


Triage in the Accident and Emergency (A&E) department is the first step for any patient admitted to a hospital. Baseline observations help to identify critically ill patients and facilitate an urgent assessment with treatment via calculation of the Modifid Early Warning Score (MEWS). The higher the score, the more urgent attention is required from a doctor. In this article we outline the Surviving Sepsis Campaign 2008 (SSC) guidelines.

Additionally, the key steps in management of the patient presenting with sepsis are summarised from the current literature. These steps include an oxygen administration, resuscitation with intravenous fluids and infusion of intravenous antibiotics. Also basic defiitions of sepsis with its subsequent stages are provided. Therefore, the reader will appreciate why a streamlined process in assessing patients in the emergency department is used, as well as have a thorough understanding of the importance of rapid and aggressive treatment of patients with sepsis.

Access the Clinical Cases Database

A subscription is required to read the full article. Please subscribe using one of the options below.

Foundation Years Clinical Cases Database£29.006 months
Add to cart
Foundation Years Clinical Cases Database£39.0012 months
Add to cart


TE Kaier (Corresponding author)

Department of Medicine
West Middlesex University Hospital
Twickenham Road

CB Narshi

Department of Medicine
West Middlesex University Hospital
Twickenham Road


1.  1. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Critical Care Medicine. 2008 Jan.;36(1):296-327.

2.  2. Marik PE, Lipman J. The defiition of septic shock: implications for treatment. Crit Care Resusc. 2007 Mar.;9(1):101-103.

3.  3. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Defiitions Conference. Critical Care Medicine. 2003 Apr.;31(4):1250-1256.

4.  4. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Defiitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992. p. 1644-1655.

5.  5. Siner JM. Sepsis: Defiitions, Epidemiology, Etiology and Pathogenesis. 2011 Jun. 22;:1-6.

6.  6. Baue AE. Multiple organ failure, multiple organ dysfunction syndrome, and the systemic inflmmatory response syndrome-where do we stand? Shock. 1994 Dec.;2(6):385-397.

7.  7. Kumar A, Kumar A, Roberts D, Roberts D, Wood KE, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock*. Critical Care Medicine. 2006 Jun.;34(6):1589-1596.

8.  8. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N. Engl. J. Med. 2001 Nov. 8;345(19):1368-1377.

9.  9. Nee PA, Rivers EP. The end of the line for the Surviving Sepsis Campaign, but not for early goal-directed therapy. Emerg Med J. 2011 Jan.;28(1):3-4.

10.  10. Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, et al. The Surviving Sepsis Campaign: results of an international guidelinebased performance improvement program targeting severe sepsis. Critical Care Medicine. 2010 Feb.;38(2):367-374.

11.  11. Annane D, S

12.  12. Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, et al. Effiacy and safety of recombinant human activated protein C for severe sepsis. N. Engl. J. Med. 2001 Mar. 8;344(10):699-709.

13.  13. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N. Engl. J. Med. 2001 Nov. 8;345(19):1359-1367.

14.  14. Vanhorebeek I, Langouche L, van den Berghe G. Tight Blood Glucose Control With Insulin in the ICU: Facts and Controversies. Chest. 2007 Jul. 1;132(1):268-278.

15.  15. Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, et al. Intensive insulin therapy in the medical ICU. N. Engl. J. Med. 2006 Feb. 2;354(5):449-461.


Conflict Of Interest

The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (

Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts ( The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

Animal & Human Rights

When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.