Sepsis scenarios test escalation as much as antibiotics. The clinical half is protocolised and quick to say; the marks that separate candidates are in what you do when you are junior, alone and not being listened to.

What is NEWS2 and what is it not?

NEWS2 aggregates six physiological parameters — respiratory rate, oxygen saturation, systolic blood pressure, pulse, consciousness or new confusion, and temperature — into a single score that triggers a defined response. It is a track-and-trigger tool. It is not a diagnosis of sepsis and it does not replace clinical judgement.

  • New confusion counts, and is easy to miss on a busy ward round
  • The SpO2 Scale 2 exists for patients with hypercapnic respiratory failure — using Scale 1 for them over-scores
  • A low score in a patient who looks unwell is a reason to escalate anyway, and saying so shows you understand the tool's limits

What do you do in the first hour?

Take three and give three, and say why each one matters rather than listing them.

  • Blood cultures before antibiotics wherever possible — but do not delay antibiotics to get them
  • Serum lactate, which measures tissue hypoperfusion and guides how sick the patient really is
  • Urine output, measured hourly
  • High-flow oxygen, titrated to the patient's target range
  • Broad-spectrum antibiotics within the hour, following local policy
  • Intravenous fluids, reassessed after each bolus rather than prescribed and forgotten

How do you escalate when you are not being heard?

This is the part the panel is really assessing, and the answer needs to be concrete. State your concern, state the objective findings, say explicitly what you want and by when, and if the response is inadequate go up the chain — the registrar, the consultant on call, the outreach or critical care team. Say plainly that patient safety outranks hierarchy and that you would document each escalation with the time. A candidate who says they would 'keep monitoring' has failed the station.

What about ceilings of care?

Expect the scenario to turn: the patient is frail, or has advanced disease, and you are asked whether escalation is appropriate. Do not guess. Say you would seek the existing treatment escalation plan or ReSPECT form, discuss with the responsible consultant, and involve the patient — or, if they lack capacity, those close to them — in a decision about what treatment would benefit them. Being comfortable saying that a decision is not yours alone to make is a strength here, not a weakness.