A deadly condition that hides in plain sight. Know the signs of sepsis

by Joshua A. Geltman, MD, MBA

You know a stroke when you see it: a drooping face, slurred speech, a weak arm. The signs of a heart attack are familiar, too: crushing chest pain, the classic clutch at the sternum. Then there’s sepsis. Despite killing more people in hospitals than any other condition, it rarely announces itself so clearly. Too often it looks like someone who “just looks sick.”

That ambiguity is deadly. Sepsis is the body’s overwhelming and dysregulated response to an infection. Instead of fighting off germs in a measured way, the immune system goes into overdrive, injuring organs and triggering a vicious cycle that can spiral in hours. Sepsis doesn’t have a single face. It can start from pneumonia, a urinary tract infection, a skin infection, a post-surgical complication, even a dental infection. It affects the young and the old, people with chronic conditions and people who were healthy yesterday. Sometimes it looks like a bad flu—until it isn’t.

When sepsis progresses to septic shock, it can be deadly for roughly a third to half of patients. I work in the intensive care unit (ICU), where we see the devastating impact it can have. Minutes matter. And since minutes are won at home, in the community, and at the hospital door — not only in the ICU — public awareness must be part of how we save lives.

Here’s what to look for, and when to act.

• Fever: a temperature of 101°F or higher. In frail or older adults, temperature can be normal or even low.
• Fast heart rate: generally more than 90 beats per minute.
• Fast breathing: more than 20 breaths per minute, or someone who looks winded at rest.
• Looking or feeling profoundly unwell: confusion, extreme weakness, clammy skin, or a concerning change from baseline in a child, a parent, or yourself.
• A suspected infection: a bad cough, a urinary tract infection, a skin wound that’s getting red and hot, dental infections, abdominal pain—any infection that seems to be worsening, not improving.

If you or a loved one has a suspected infection plus a combination of these signs — particularly fever, fast heart rate, and fast breathing — don’t wait for it to “pass.” Seek care immediately. At the hospital, early IV fluids, antibiotics, and what we call “source control” (draining an abscess, removing an infected appendix or gallbladder, treating a severe UTI) can stop the downward spiral before it injures organs. If you’re worried, say the word “sepsis” at triage.

In the emergency department and across the hospital, we live by this urgency. At Northern Westchester Hospital, our teams aim to meet or beat national benchmarks that require critical steps within one hour, three hours, and six hours of identifying sepsis. That includes evidence-based steps tied directly to better survival and better recoveries. We also have a sepsis committee, which brings together leaders from various specialties — emergency medicine, pediatrics, obstetrics, surgery and more — as well as ancillary staff. Through this committee, we have built systems to improve diagnostic speed, treatment and our patients’ chances of a good outcome, because culture and process save minutes — and minutes save lives.

Code sepsis

We created “Code Sepsis,” an overhead alert that anyone can call when a patient meets criteria: a nurse, a doctor, a patient care associate taking vital signs, even a transporter moving a patient between tests. That single call mobilizes a team to the bedside, kicks off labs and antibiotics, and ensures nothing waits for “later.”

Sepsis superheroes

We have made sepsis recognition part of our culture. We quiz teams across units on the signs. We celebrate a “Sepsis Superhero of the Month” for the person who spotted early warning signs and escalated care. We even don capes now and then to keep the message memorable. It’s lighthearted on the surface, but the aim is serious: keep sepsis top of mind for everyone, because anyone can be the first link in the chain that saves a life.

Universal sign-out sheet

We standardized handoffs between the emergency department, operating rooms, the ICU, and hospital floors so that IV fluids and antibiotics started in the emergency department aren’t delayed upstairs and fluids are continued seamlessly. This universal sign-out sheet helps to better track a patient's "sepsis journey."

Reinvigorate Sepsis campaign

Across Northwell Health, every department runs targeted quality-improvement projects each quarter to shave delays, strengthen recognition and close gaps.

These efforts have a clear impact: earlier recognition, faster treatment, better odds. Over the past year, our hospital has significantly increased our adherence to the three- and six-hour “sepsis bundles,” the time-sensitive steps that national research links to survival. We’re hardwiring the most effective tactics — from checklists to Code Sepsis — into our standard practice.

But the chain that saves a life starts before any of that — when a family member notices breathing that seems too fast, a fever that won’t break, a parent who suddenly seems confused, or a wound that’s getting angrier by the hour. The biggest difference you can make is recognizing when common infections stop behaving like “common” and start behaving like sepsis.

When you recognize that shift and seek help, you give us what we need most: time. And in a fight measured in minutes, time is a lifesaving gift.

Joshua A. Geltman, MD, MBA, is an attending physician at Northern Westchester Hospital. He is board certified in internal medicine, emergency medicine and critical care medicine.