Two Emergencies, One Aide
You are the only nursing assistant in the dining room at 8:10 a.m. with 14 residents. Mrs. Chen, 74, has a documented seizure disorder; her last seizure was eight months ago and no PRN rescue medication is ordered. She sits in her wheelchair at a table with four other residents. Suddenly her eyes deviate to the right, she makes a gurgling sound, and she begins to slide forward in the chair. At the same table, Mr. Doyle, 81, on a regular diet, has just taken a large bite of toast. He is making no sound at all, his face is turning dusky red, and he is gripping the table edge. The nearest call light is six feet away; the nurse is at the far end of the building.
1. Which resident do you attend first, and what is your very first action?
Read the worked answer
First action, before either resident: shout for help and hit the call light. You cannot manage an airway alone and simultaneously protect a seizing resident. Two seconds of noise buys you a second pair of hands and a 911 call. This is triage, not indecision.
Then Mr. Doyle. Reasoning:
- Silent choking with a color change is a complete airway obstruction. Brain injury begins in minutes. Mrs. Chen's seizure began seconds ago; the immediate risk to her is injury, which you can partly control by clearing space around her.
- Seizures are usually self-limiting; a witnessed seizure in a resident with a known disorder is not, by itself, a 911 call.
- On your way past, push Mrs. Chen's chair away from the table edge or lower her to the floor if you can do it safely - she is sliding out of the chair and could strike the table or floor.
- Deliver back blows and abdominal thrusts per your training, standing Mr. Doyle if he can bear weight. Stay with him until the object is out and he is breathing and speaking.
Do not leave the room, and do not start CPR on a person who is moving air or has a pulse.
2. How do you care for Mrs. Chen during and immediately after the seizure?
Read the worked answer
During:
- Time it. Note the start time on the clock, not by feel.
- Protect the head with something soft; move furniture, not the person.
- Do not restrain her limbs and put nothing in her mouth. Restraining causes fractures; objects cause broken teeth and airway obstruction.
- Loosen anything tight at the neck and note what you see: which side, eye deviation, incontinence, color.
After:
- Turn her to her side once the movements stop - she is postictal and at risk for aspiration of saliva.
- Stay with her. She will be confused, may be incontinent, and may not know where she is. Reorient gently in short sentences; do not flood her with questions.
- Report to the nurse immediately - she decides whether 911 is needed. Escalate if the seizure passes 5 minutes, a second seizure starts without her waking between, she is injured, or she has trouble breathing.
- Change her clothing discreetly and protect her dignity in front of the other residents.
3. What must be documented and reported before the end of your shift?
Read the worked answer
Document facts and times, not conclusions. For Mrs. Chen: onset time, what you observed (eye deviation, gurgling, sliding forward), duration, that you protected her head and did not restrain or place anything in her mouth, time movements stopped, side-lying position, level of orientation afterward, who you notified and when.
For Mr. Doyle: what he ate, that he was silent and dusky, back blows/thrusts given, time the object cleared, that he was speaking and breathing normally afterward, and that the nurse evaluated him.
What to leave out: "she seemed fine," "he looked better" - those are opinions and they hide change.
Reporting:
- Verbal report to the nurse the same shift, not at handoff. A choking episode and a seizure both need a nursing assessment, and Mr. Doyle's diet texture and eating pace should be reviewed.
- You do not decide on hospital transfer or a diet change. You supply the observations; the nurse and SLP decide.
- If this was Mrs. Chen's first seizure in eight months, that pattern belongs in the record and in her care plan discussion.