🩺 1. A Real-World Scenario

🩺 1. A Real-World Scenario

It’s 19:30 in Resus on a busy winter evening.
 A 64-year-old man arrives from a nursing home with fever, confusion, and a respiratory rate of 28. His systolic BP is 91 mmHg, HR 112, and he is not maintaining saturations on air. The triage nurse asks, “Could this be sepsis again?”

Such cases define daily Emergency Medicine — and remain central to both RCEM Best Practice
and the Final FRCEM SBA Exam standards
.

📚 2. Sepsis 2025 — Key Guideline Updates

RCEM Best Practice Guideline (2025) integrates the NICE NG51 framework with UK-specific emergency priorities:

Domain                                                       2025 RCEM Update                                                                                                                          Clinical Impact 

Early Recognition                            | NEWS2 ≥ 5 = high risk; Red-Flag Sepsis if lactate > 2 mmol/L or SBP < 100 mmHg        | Escalate to senior ED clinician immediately
Time-Critical Actions                                         | IV antibiotics + fluids within 60 minutes                                                               | “Golden Hour” reinforced
Antibiotic Choice                                           | Follow local AMS policy; avoid automatic broad spectrum                                       | Tailor to source and risk
Lactate Measurement                                    | Point-of-care mandatory in Resus/Majors                                                                | Repeat after 2–4 h if > 2
Reassessment                                            | Senior review within 1 h of recognition                                                                      | Document decision clearly
Imaging                                                       | CT/US source search after stabilisation                                                                    | Prevent antibiotic delay

For full contextual notes, see Clinical Guidelines Hub → Sepsis
.

🧬 3. Emergency Department Priorities

Recognition

• Use NEWS2 ≥ 5 or any Red Flag.
• Maintain suspicion in elderly, immunosuppressed, post-operative, or pregnant patients.
   (See also Red Flag Recognition Toolkit
  .)

Immediate Management

1. O₂ (aim SpO₂ > 94 %).
2. IV access × 2 → blood culture + lactate.
3. IV crystalloid 30 mL/kg (20 mL/kg if cardiac failure).
4. Empirical antibiotic within 60 min (local policy).
5. Early senior review → consider ICU referral.
6. Document sepsis bundle completion time.

Cross-link: Fluid Resuscitation in Shock – RCEM 2024 Update
.

🧩 4. Final FRCEM Exam Focus

Expect SBAs testing:

• Recognition of subtle sepsis in immunosuppressed patients
• Hour-one bundle sequencing
• Antibiotics vs imaging timing
• Lactate interpretation and re-measurement
• Red Flag vs Amber Flag criteria

Try related practice set: Sepsis SBA Demo Pack → Free Access

📖 5. Study Zone Summary © FRCEM Study Zone | www.FRCEMStudyZone.co.uk

• Recognise early → NEWS2 ≥ 5 or Red Flag.
• Administer antibiotics + fluids within 60 min.
• Repeat lactate > 2 mmol/L after 2–4 h.
• Senior review within 1 h.
• Document bundle completion.
• Practise exam-aligned questions on our Emergency Medicine Question Bank
  .

🔗 6. References

• RCEM Best Practice Guideline: Sepsis (2025)
  
  
• NICE NG51: Sepsis Recognition, Diagnosis and Early Management (2024 update)
  
  
• Resuscitation Council UK Sepsis Algorithm (2024)
  
  

🗣️ 7. Call to Action

🎯 Ready to test your knowledge?
Practise 10 consultant-level SBA questions on Sepsis — aligned to the RCEM 2025 guideline — only on 👉 www.FRCEMStudyZone.co.uk/demo/sepsis-sba-demo

🧭 8. Category Tags for Website

• Category: Clinical Guidelines
• Sub-Category: Sepsis & Infectious Diseases
• Tags: RCEM Guideline 2025, Final FRCEM SBA, Emergency Medicine UK, NICE NG51, Sepsis bundle, Study Zone Blog