Suspected urinary-source sepsis

PLAB 2 & PRES 3 · emergency · hard · 8 minutes

Candidate brief

You are an FY2 doctor/SHO in the Emergency Department. Mr Shah, 72, has had 2 days of dysuria, fever and increasing weakness. Observations: HR 118, BP 88/54, RR 24, temperature 38.8°C and SpO₂ 94% on air. Assess him, explain your concerns and initiate immediate management. Verbalise any examination or actions you would perform.

What examiners look for

Treat the unstable patient before completing a long history. Suspected infection with hypotension, hypoperfusion or new organ dysfunction requires immediate sepsis assessment and senior escalation. Use ABCDE, obtain cultures and lactate, start prompt local IV antimicrobials, give balanced crystalloid in reassessed boluses, monitor urine output and identify whether source control is needed. Do not give routine high-flow oxygen when saturation is already within the target range. Reassess frequently and involve critical care early if hypotension persists despite appropriate fluid resuscitation.

Guideline references

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