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Suspected sepsis with evidence of hypoperfusion — MRCEM SBA MCQ

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HardInfection and sepsisSuspected sepsis with evidence of hypoperfusionMRCEM SBA

A 63-year-old man presents to the emergency department with fever and rigors. There is no clear source of infection. His temperature is 38.3°C, pulse 112/min, respiratory rate 22/min, blood pressure 126/74 mmHg and oxygen saturation 97% on air. He is alert. His first NEWS2 score is 5, and venous lactate is 2.7 mmol/L. Blood cultures have been taken. He has received neither antibiotics nor intravenous fluids. He has no signs of fluid overload or known cardiac or renal failure. Which initial treatment plan is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Give broad-spectrum intravenous antibiotics within 1 hour and an initial 250 mL crystalloid bolus, then reassess.

A NEWS2 score of 5 initially places this patient in the moderate-risk group, but his lactate is above 2 mmol/L. NICE recommends managing a patient at moderate risk who has evidence of hypoperfusion as high risk. A normal systolic pressure does not negate that finding. ([nice.org.uk](https://www.nice.org.uk/guidance/ng253/chapter/Evaluating-risk)) For high-risk suspected sepsis, give broad-spectrum intravenous antibiotics within 1 hour of calculating the first NEWS2 score in the emergency department. Give an intravenous fluid bolus without delay unless contraindicated. The recommended initial bolus is 250 mL of isotonic crystalloid, ideally over 10–15 minutes, followed by reassessment; further 250 mL boluses may be given if needed. Senior clinical review and investigation for the source should proceed alongside treatment. ([nice.org.uk](https://www.nice.org.uk/guidance/ng253/chapter/Managing-suspected-sepsis)) A applies the possible 3-hour antibiotic window for moderate risk despite evidence of hypoperfusion. C gives 1,000 mL as a single initial bolus rather than reassessing between smaller boluses. D incorrectly makes hypotension a prerequisite for fluids. E uses a 500 mL initial bolus instead of the recommended 250 mL; a cumulative 500 mL may be appropriate after reassessment. ([nice.org.uk](https://www.nice.org.uk/guidance/ng253/chapter/Managing-suspected-sepsis))

Reference: NICE NG253: Evaluating risk (19 November 2025) — https://www.nice.org.uk/guidance/ng253/chapter/Evaluating-risk NICE NG253: Managing suspected sepsis (19 November 2025) — https://www.nice.org.uk/guidance/ng253/chapter/Managing-suspected-sepsis NICE NG253: Suspected sepsis in people aged 16 or over, recommendations 1.8.4–1.8.9 (19 November 2025) — https://www.nice.org.uk/guidance/ng253/resources/suspected-sepsis-in-people-aged-16-or-over-recognition-assessment-and-early-management-pdf-66144015386053