GOALS: Recognize sepsis and review the differential diagnosis; identify systemic infection before it progresses to decompensated shock; and identify patients who require evacuation.

Infection may take many forms in initial presentation. Common examples include viral upper respiratory infections, gastroenteritis, urinary tract infections, cellulitis, and pneumonia. In addition, infections associated with travel, to include diarrhea, vector-borne diseases (malaria, dengue fever, etc.) and some respiratory pathogens will be particularly common in certain areas of the world. A comprehensive history of illness, to include travel history, should be obtained initially. Many infections may be managed adequately without evacuation or need for higher levels of medical care.

Differential diagnoses of presentations attributed to infections must be considered as well. Sepsis “mimics” anaphylaxis, gastrointestinal emergency, pulmonary disease including pulmonary embolism, metabolic abnormality including hyperthyroidism and adrenal insufficiency, toxin ingestion, toxin withdrawal, vasculitis, and spinal injury.4 If the condition progresses to septic shock, “mimics” may include other causes of shock such as myocardial infarction, gastrointestinal bleeding, dehydration, heat injury, and hypovolemia secondary to gastrointestinal losses. If infection and sepsis are still prominent in the differential diagnosis after considering these other causes of shock, a focused assessment should be pursued, as detailed below. Any patient showing evidence of sepsis or septic shock should immediately be classified as an urgent evacuation priority.