The following clinical signs must be measured and recorded to complete a full assessment:

• Temperature
• Heart rate
• Respiratory rate
  
• Blood pressure
  
  
• Capillary refill time or toe-core temperature gap
  
  Standard technique for measurement of CRT is to press for 5 seconds on a fingertip or toe, or on the centre of the sternum, and count the seconds it takes for colour to return. (Capillary refill shown here on dorsum of foot to facilitate capture on film.)
  
• Oxygen saturation measurement (normal value is >95% in air)
  
  
• Assessment of conscious level (AVPU)
• Pupil size and reaction
• If rash present record whether it is blanching, extent of rash, speed of development and whether it is petechial or purpuric (Petechial <2mm diameter, purpuric >=2mm diameter). Purpura are highly predictive of meningococcal disease and should be treated as an emergency, with immediate antibiotics and admission. Petechiae alone are less predictive, but must be taken very seriously and especially in combination with other features of septicaemia should provoke urgent action.

Full-blown non-blanching haemorrhagic rash*