Fever & Sepsis

1 · First minutes

1. Screen with NEWS2, MEWS, or SIRS — not qSOFA alone.
2. Host first: age, neutropenia, devices, pregnancy, travel.
3. Shock or probable sepsis: antibiotics within 1 hour. Possible sepsis without shock: rapid look, then within 3 hours if infection remains likely.

3 · Immediate workup

• Glucose, lactate, pregnancy test when appropriate
• POCUS: effusions, hydronephrosis, cardiac function

4 · Don’t miss

• Sepsis / septic shock
  Hypotension, tachypnea, altered mentation, lactate >2. Antibiotics within 1 h for shock or probable sepsis; within 3 h for possible sepsis without shock after a rapid look. Use balanced crystalloid for initial resuscitation and dynamic measures to guide further fluid. Begin norepinephrine if MAP remains low during resuscitation (SSC 2026).
• Necrotizing soft-tissue infection / toxic shock
  Pain out of proportion, rapid spread, crepitus, or shock with a wound/soft-tissue source — surgery now, not a wait-for-CT strategy.
• Neutropenic fever
  ANC <500 + a single temperature ≥38.3°C (or ≥38.0°C for 1 h) — immediate empiric antipseudomonal antibiotics. MASCC/CISNE may identify low-risk outpatient candidates.
• Bacterial meningitis
  Fever + meningismus/altered mentation — first dose of antibiotics (and dexamethasone if pneumococcal likely) must not wait on CT.
• Infective endocarditis
  Fever + new murmur, IVDU, embolic signs — blood cultures ×3, echo.