OET Reading Part A
Sepsis: Texts
Text A
Sepsis: where it begins and who is vulnerable
Sepsis is life-threatening organ dysfunction caused by the body’s dysregulated response to infection. The harm comes not from the organism but from the reaction it provokes. Although treatment happens in hospital, most cases begin in the community.
Infection at any site can be responsible. The chest accounts for the largest share of cases; the abdomen ranks immediately below it, ahead of the urinary tract, with skin and soft tissue accounting for much of the remainder.
Susceptibility is increased in:
- infants under 1 year, adults over 75 and anyone who is frail
- patients whose immunity is impaired, including those on long-term corticosteroids or chemotherapy
- anyone who has had surgery or an invasive procedure within 6 weeks
- women who are pregnant, or who have given birth, miscarried or ended a pregnancy within 6 weeks
- people who inject drugs
- patients whose skin is broken by cuts, burns, blisters or infection
Urinary catheters, cannulas and central lines deserve separate mention: each offers organisms a route past the outer defences.
Sepsis after childbirth deserves particular suspicion; group A streptococcus is of greatest concern.
Fever in a patient on chemotherapy whose neutrophil count is 0.5 × 10⁹/L or lower is neutropenic sepsis, a medical emergency.
Text B
Recognising sepsis
No single test confirms sepsis. Recognition rests on the observations, on the trend they describe and on suspicion of infection.
Deterioration is tracked with the NEWS2, a tool which scores seven parameters:
| Parameter | Recorded as |
|---|---|
| Respiratory rate | breaths per minute |
| Oxygen saturation | Scale 1, or Scale 2 where a lower target range has been prescribed |
| Supplemental oxygen | air, or oxygen being given |
| Systolic blood pressure | mmHg |
| Pulse | beats per minute |
| Consciousness | ACVPU – alert, new confusion, voice, pain, unresponsive |
| Temperature | degrees Celsius |
Each parameter scores points, and the points are added together. A total of 5 or 6 indicates moderate risk and 7 or more high risk; any single parameter scoring 3 prompts medical review.
Observations can reassure falsely. A normal temperature does not exclude sepsis, and frail or immunosuppressed patients may be cold rather than hot. Patients taking beta-blockers may not show the expected rise in pulse. Blood pressure is often preserved until late, particularly in younger adults and during pregnancy.
Mottling, cyanosis and a rash that does not fade under pressure are grave signs that demand immediate action.
Text C
Treatment on recognition
Once sepsis is suspected and the risk is high, six actions are completed within one hour. Three take something from the patient; three give something to them.
- Take blood cultures before antibiotics, where this causes no delay.
- Measure lactate on a venous blood gas.
- Record urine output every hour.
- Give oxygen, targeting saturation of 94–98%, or 88–92% where carbon dioxide retention is a risk.
- Give a broad-spectrum antibiotic at the maximum recommended dose.
- Give a bolus of balanced crystalloid: 250 mL over 10 to 15 minutes.
Antibiotics are given intravenously. Where venous access proves difficult, use an intraosseous needle rather than waiting.
Reassess after each bolus and repeat to a total of 1,000 mL; seek senior advice before going beyond this.
Nothing in this sequence should be delayed while the source of infection is looked for.
Text D
Treatment continues after the initial resuscitation. Reassess at least hourly until the patient is clearly improving.
A lactate above 2 mmol/L is evidence of hypoperfusion, as is acute kidney injury; a systolic pressure below 90 mmHg is a further red flag. If the patient has not responded within an hour of any intervention, the senior decision maker must attend in person, critical care must be involved and the responsible consultant informed. Where the blood pressure remains low despite fluid, discuss vasopressors with critical care; these may be started peripherally.
Where pus has collected or an implanted device is infected, antibiotics alone rarely succeed. The focus must be dealt with – source control – as soon as the patient can tolerate it.
Culture results usually return within 48 hours. Review the antimicrobial against them, narrowing the spectrum where possible.
Not every patient will benefit from organ support. Where this is uncertain, discuss it early with the patient and those close to them, and record the outcome as a treatment escalation plan, so the position is clear overnight.