Two medical emergencies at the same time in AMU-A and observation bay which are next to each other.
I was an on-call SHO covering the back wards but I still come down to help
Initially I thought it’s mis-interpretation of the location by the operator or whoever put out the emergency call. However, it really was two medical emergencies at the same time. I popped in to the observation bay first which is nearer to me and found medical staff including emergency doctors are helping a person to get up and nursing staff are assisting. As soon as I realized the nature of calm situation in possible vasovagal attack, I moved on to the next emergency in the AMU-A where a young lady with known h/o non-epileptic seizures is seizing now. Medical Registrar and another junior doctor was already there, and the nurses are helping with positioning, airway, oxygen, etc. We have given a dose of lorazepam as per Trust guidelines and checked the ABG not to miss any reversible causes or precipitants.
While covering the medical wards as an on-call SHO, two simultaneous emergency calls were put out for adjacent areas: the Observation Bay and AMU-A. Initially suspecting a communication error, I arrived to find two genuine incidents. I first triaged the Observation Bay, where I found a patient who had suffered a vasovagal syncopal episode; the situation was well-managed by the ED team. I then immediately transitioned to AMU-A to assist with a young female patient experiencing a prolonged seizure. She had a known history of non-epileptic attacks (NEAs), but we managed the episode as an acute seizure following Trust guidelines. Under the supervision of the Medical Registrar, we secured the airway, administered oxygen, and gave intravenous lorazepam. We also performed an arterial blood gas (ABG) to exclude metabolic precipitants.
Initially, I felt confused by the dual emergency calls, which created a sense of urgency and slight cognitive overload. However, by physically attending the first site, I was able to quickly assess that the "vasovagal" patient was stable and that my skills were more needed elsewhere. I felt more settled once I joined the team in AMU-A, as there was a clear leadership structure (the Registrar) and a defined protocol to follow.
This scenario is a classic example of Situational Awareness. In a high-pressure environment like an AMU, clinicians must constantly reassess which task has the highest clinical priority. Regarding the seizure management, even with a history of NEAs, we correctly followed the status epilepticus protocol. This is crucial because a history of NEAs does not preclude a patient from having a genuine tonic-clonic seizure or suffering from hypoxia during an episode. The use of ABG was a vital step to check for hypoglycemia, electrolyte imbalances, or significant acidosis.
I learned that when faced with "double" emergencies, the first step is a quick visual triage. You cannot help if you do not know who is the most unstable. I also reaffirmed the importance of treating every seizure as a medical emergency regardless of past history until the patient is stabilized.