The Doctor Will See You Now [Non-Fiction]

Chapter 117: Acute Medicine

During a particularly awful, hectic week, I am on call, and my pager goes off. It was the surgery house officer, who tells me over the phone there is a patient under their care who has been seizing for fifteen minutes and counting.

Record scratch. Fifteen minutes? Longer than two minutes warrant benzodiazepines to terminate the seizure. Longer than five minutes is status epilepticus, a medical emergency that warrants ICU admission. This person has allegedly been seizing for fifteen minutes nonstop. The brain will be fried.

I asked what they have done so far.

HO: the blood sugar is low.

Me: so have you given them some dextrose (IV sugar solution)?

HO: no, we haven't got venous access yet (the plastic tube for giving medication into a vein has fallen out).

Me: so have you given benzodiazepines to terminate the seizure?

HO: no, we haven't got venous access.

Me: but you know there are other ways to give benzodiazepines? (Namely into the muscle, fat, into the rectum. There are also other ways to raise the blood sugar without an IV access, which they haven't done, either).

HO: Oh.

When I arrived two minutes later, the patient is unconscious but no longer seizing. The house officer had given the benzodiazepine and terminated the seizure. I do a brief examination and ask the HO why they didn't give the benzo.

"I didn't think of it," they said sheepishly.

I appreciate people panic when it comes to emergencies. But this HO has been a doctor for a year at this point. There are certain things that are automatic: the CPR sequence; low blood pressure warrants quick IV fluids; heart attack warrants aspirin; low blood sugar warrants IV sugar solution.

Seizures warrant benzo.