There is a category of clinical situation where the FY1 job description is short and non-negotiable: recognise it, start the basics within your competence, and get senior help early. Not manage it alone, not look it up first, not wait to be sure. These ten belong to that category, and knowing them cold, as recognition patterns with an escalation reflex attached, is the single highest-yield preparation for the first months. The frame for all ten: ABCDE every time, the early warning score's triggers treated as instructions, your trust's protocols as the playbook, and the standing rule that if you are wondering whether this needs a senior, it does.
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The hypotensive, possibly septic patient. New hypotension, especially with fever, tachycardia, confusion or a climbing early warning score, is an emergency until proven otherwise. Assess, start your trust's sepsis pathway within your competence, and call while doing so, not after; sepsis rewards minutes.
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Chest pain. Assess in person, every time, with early ECG and observations, and escalate anything with cardiac features, haemodynamic change or an abnormal trace, and anything that simply worries you. The differential includes several killers; the FY1's job is recognition and the call, not exclusion.
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Acute breathlessness or hypoxia. New oxygen requirement, rising respiratory rate or falling saturations is a deteriorating airway-breathing problem with a wide dangerous differential. ABCDE, oxygen per local policy, senior involvement early, and outreach or the emergency call if the trajectory is steep.
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Gastrointestinal bleeding. Melaena, haematemesis or unexplained haemodynamic compromise in a patient with risk factors: assess, secure access and send bloods within your competence, and escalate immediately, significant GI bleeding is a team sport with time-critical decisions above FY1 level.
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The falling GCS. New drowsiness or a dropping conscious level is never observed onto the next round. ABCDE with particular attention to airway protection, glucose checked, and a senior involved urgently, with a low threshold for the emergency team if the decline is rapid.
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Dangerous electrolyte and kidney derangement, hyperkalaemia above all. A significantly elevated potassium, especially with ECG changes or in the context of acute kidney injury, is a treat-now emergency: follow the local protocol, get an ECG, and escalate immediately rather than titrating alone.
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Seizure. Manage the immediate safety basics, protect from harm, recovery position when possible, oxygen, glucose check, time it, and call early, particularly for a first seizure, a prolonged one, or failure to recover; ongoing seizure activity is an emergency-call situation, not a corridor consultation.
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Anaphylaxis. Sudden airway, breathing or circulatory compromise with an allergic trigger or suggestive features: this is an emergency-call-and-treat-per-algorithm situation from the first moment, following your resuscitation training and local protocol, with senior help summoned as the algorithm assumes.
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Hypoglycaemia that does not resolve. Treat per your trust's protocol promptly; the escalation trigger is the abnormal course, hypoglycaemia that recurs, fails to respond, or occurs with reduced consciousness, or in contexts like liver failure or overdose. Persistent or complicated hypoglycaemia needs senior input, not another cycle of the same treatment.
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The head injury on anticoagulation, and the fall with red flags. Any head injury in an anticoagulated patient is significant until imaging and seniors say otherwise; escalate rather than observe. The same reflex applies to falls with loss of consciousness, new neurology, or inability to explain the fall, the fall is often the symptom, not the event.
Two closing disciplines make the list work. First, the call itself is a skill: the one-line patient, the observations and trend, what you have done, what you are asking, rehearsed at /blog/how-to-ask-a-senior-for-help-new-doctors, and worth practising before the night it matters. Second, recognition is trainable: these ten as written are a reading exercise, but drilled as cases, presented cold, committed on, reviewed, they become reflexes, which is precisely the drilling an adaptive question set with a Socratic review layer automates, and the five-minute daily version is at /blog/five-minute-clinical-reasoning-daily-habit-new-doctors. The list belongs in your head; the reflex belongs in your training schedule; and the on-call shift it prepares you for is walked through at /blog/your-first-medical-on-call-new-doctors-guide.
Frequently asked questions
Isn't escalating all of these over-cautious for some presentations?
The list is calibrated for the new doctor precisely because early-career recognition cannot yet safely separate the benign version from the dangerous one at speed; that separation is the senior's job, reached via your call. Over-escalation on this list costs minutes; the opposite costs more.
What about presentations not on the list?
The list is a floor, not a ceiling: the standing rule, wondering means call, covers everything else. No senior has ever ended a career review with "called too often about sick patients".
Should I memorise the management of these ten as well?
The recognition and first-response basics, yes; the definitive management, no, that is what the team you summon is for, and local protocols vary. Your revision time is better spent making the recognition automatic than memorising algorithms above your role.