Is It Just a Cold…or Is It Sepsis?

Earlier this year, the sports world was stunned by the unexpected death of NASCAR champion Kyle Busch. At just 41 years old, Busch was a professional racecar driver at the top of his game. He had reportedly been fighting what he described as a “cold.” That cold turned out to be pneumonia. The pneumonia turned into ^sepsis.¹ And just like that, one of the best drivers in NASCAR history was gone.

As clinicians, this one hit differently. Because Kyle's story isn't just tragic; it's a reminder that sepsis doesn't come with a warning label, and it doesn't only happen to the patients that we expect.

Sure, we keep our clinical antennas up for the patients with obvious risk factors: older adults, the immunocompromised, diabetics, and the patients with chronic kidney disease. But the reality? Sepsis can show up in anyone who walks through your door, from a nursing home resident to a professional athlete. Urgent care clinicians are often the first healthcare professionals with an opportunity to recognize it. Here’s a stat that keeps me up at night: more than 87% of sepsis cases originate outside the hospital.² That means we — urgent care clinicians — are on the frontlines of recognizing sepsis.

So What Is Sepsis?

Sepsis⁵ is a life-threatening medical emergency that occurs when the body's response to an infection goes completely off the rails. The underlying process is surprisingly complex. The body's immune response to infection becomes excessive and disorganized, triggering widespread inflammation and microvascular damage. The result is impaired tissue perfusion, reduced oxygen delivery, and eventually organ dysfunction. Left unchecked, sepsis spirals into organ dysfunction and multi-organ failure.

Septic shock is the scariest end of the spectrum: profound circulatory collapse that doesn't respond to fluids. According to the CDC,³ 1 in 3 adults who die in the hospital have sepsis. Let that sink in. Early recognition is everything.

Who’s Most At Risk?

While sepsis can happen to anyone, some patients are at higher risk than others:

• Adults ≥ 65 years old

• Immunocompromised patients or anyone with a weakened immune system

• Diabetes

• Chronic kidney or liver disease

• Obesity

• Active cancer

• Indwelling devices such as urinary catheters or central lines

• Recent hospitalization or surgery

But here's the catch: risk factors raise the probability. They don't define the possibility. Remember, sepsis can happen to anyone.

Red Flags You Shouldn’t Ignore

The signs and symptoms of sepsis are sneaky and often hiding in plain sight. Patients rarely walk in saying they feel septic. They come in with a cough, a sore throat, "the flu," a UTI, or just feeling wiped out.

Watch out for:

• Tachypnea or shortness of breath

• Tachycardia (high heart rate)

• Hypotension (low blood pressure)

• Fever, chills, or hypothermia

• Altered mental status or new confusion

• Slurred speech

• Delayed capillary refill

• Cool or clammy skin

• Ill or toxic appearance

Three of these findings deserve a special mention here:

• Altered mental status — often one of the earliest signs of organ dysfunction.

• Tachypnea — one of the first objective vital sign abnormalities in sepsis and one of the most commonly missed.

• Hypotension — often a late, ominous finding that may mean your patient is in early septic shock.

Even without a fever or an obvious source of infection, these findings deserve your attention.

Finding the Source (But Don’t Get Stuck On It) Without Getting Stuck on the Source

It's worth thinking through the usual suspects. Pneumonia tops the list of sepsis sources,⁴ making pulmonary infections the first place many clinicians look. Patients may present with the classic symptoms of cough, fever, and dyspnea — or with something far less obvious, such as weakness, fatigue, confusion, or a fall.

Urinary tract infections and pyelonephritis are another common source. Abdominal infections such as appendicitis, cholecystitis, and peritonitis can also lead to sepsis. Skin and soft tissue infections, including cellulitis, should also remain on your differential.

But here's your urgent care pearl of the day: you do not need to identify the source before escalating care. A patient with suspected sepsis and no obvious source is still a patient with suspected sepsis. Get them to the emergency department immediately.

Clinical Calculators That Can Help

No calculator diagnoses sepsis, but several tools can support your bedside assessment.

If you're looking for a useful urgent care screening tool, NEWS2 can support your assessment. Current guidelines favor NEWS/NEWS2, MEWS, or SIRS over qSOFA when using a single sepsis screening tool.

National Early Warning Score (NEWS) 2

The score incorporates:

• Respiratory rate

• Oxygen saturation

• Supplemental oxygen use

• Systolic blood pressure

• Heart rate

• Temperature

• Level of consciousness

NEWS2 Interpretation

• 0–4 = Lower risk

• 5–6 = Time for urgent clinical review

• ≥7 = High risk requiring immediate escalation

Importantly, NEWS2 outperforms qSOFA for catching patients who are about to deteriorate.

Systemic Inflammatory Response Syndrome (SIRS) Criteria

For many of us, we know the SIRS criteria like the back of our hand. SIRS is your sensitive screener — good for flagging patients who might have an infection.

SIRS Criteria (2 or more = meets criteria):

• Temperature >38°C (100.4°F) or <36°C (96.8°F)

• Heart rate >90 bpm

• Respiratory rate >20 breaths/min or PaCO₂ <32 mmHg

• WBC >12,000/mm³, <4,000/mm³, or >10% bands

  
  
  

qSOFA (Quick SOFA Score)

qSOFA is simple and easy to remember and is a specificity tool. It’s better for identifying which infected patients are headed toward serious trouble.

• Respiratory rate ≥22

• Systolic BP ≤100 mm Hg

• Altered mental status

A score of 2 or greater identifies patients at increased risk for poor outcomes.

However, qSOFA should not be used as a standalone screening tool because many septic patients will initially score only 0 or 1.

None of these clinical calculators diagnose sepsis on their own, but together, they can be helpful screening tools to use at the bedside.

The Gray Zone Patient

You know this patient. Vitals are borderline. NEWS2 hasn't crossed a threshold. qSOFA is 1. But something is off. The patient looks “sick”. Not the “they’re sick” look, but the “sick sick” look. It’s a look all of us urgent care clinicians have seen before, and when you’ve seen it once, you don’t forget it.

That's your clinical gestalt talking. When in doubt, err toward transfer. Document your reasoning and don't let a reassuring number talk you out of a concerning gut feeling. Sepsis is diagnosed clinically, not by a particular lab value or clinical calculator score.

What Should Urgent Care Actually Do?

Shift your mindset: you are not diagnosing or ruling out sepsis. You are risk-stratifying the patient and deciding on next steps.

Point-of-care testing like lactate, influenza, CBC, and UA can provide valuable information if it's available and fast. But ask yourself honestly: will this result change my management? In most cases, if a patient is sick enough to make you consider a lactate, the patient is sick enough to need ED evaluation.

In the meantime:

• Call EMS (don't let these patients drive themselves)

• Oxygen, if hypoxic

• IV access, if you can get it

• IV fluids, preferably crystalloids like Lactated Ringer’s for hypotension or elevated lactate

• Adults: Initial bolus at 30 mL/kg

• Call ahead to the receiving ED, so they're ready

  
  

The Takeaway

Sepsis doesn't care that your patient is young and healthy. It can happen to anyone. When your patient has that elevated sick look and your clinical radar is going off, don’t ignore it. Time is of the essence with sepsis. Save a life and get that patient to the ED.

References: 

1. Associated Press. Kyle Busch had pneumonia for 'days to weeks' before death. ESPN. May 28, 2026. Accessed August 28, 2026. https://www.espn.com/racing/nascar/story/_/id/48903045/kyle-busch-had-pneumonia-days-weeks-death

2. Balch B. Sepsis is the third leading cause of death in U.S. hospitals. But quick action can save lives. AAMC News. October 10, 2023. Accessed August 28, 2026. https://www.aamc.org/news/sepsis-third-leading-cause-death-us-hospitals-quick-action-can-save-lives

3. Centers for Disease Control and Prevention. About sepsis. Updated August 17, 2026. Accessed August 28, 2026. https://www.cdc.gov/sepsis/about/index.html

4. Ceccato A, Torres A. Sepsis and community-acquired pneumonia. Ann Res Hosp. 2018;2:7. doi:10.21037/arh.2018.06.01

5. Centers for Disease Control and Prevention. Caring for patients with sepsis. Updated August 19, 2025. Accessed August 28, 2026. https://www.cdc.gov/sepsis/hcp/clinical-care/index.html