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A 59-year-old male of non-English speaking background with no known medical history presented to the emergency department with sepsis and confusion. He was tachycardic (120 bpm), hypotensive (90/55 mmHg) and febrile (38.4 C) with a large 15 × 13 cm left flank necrotic skin infection with crepitus (Fig. 1). Biochemical findings revealed leucocytosis (32 g/L), anaemia (haemoglobin 51) and C-reactive protein (230 g/L). Venous blood gas was suggestive of a metabolic acidosis: pH (7.39) and lactate (12.17 mmol/L). He

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