The bolded. Although, unfortunately, whether or not you get the first spin from the resident or not.... can depend on a number of factors. I've had seniors you practically had to BEG and cajole into helping or seeing your quite ill patient. You hope this doesn't happen. It's true that the best intern armor is deflecting too much responsibility by kicking things up the chain. It's saved my ass. I've had times I had to go above the senior to the attending. It's something you really, really, don't want to do, but you can't let your patient sink with you in the boat too. "But the senior/attending told me to" is a really good response early on, unless it's something so stupid even an intern should know it is not a good idea to follow through on. Paging or texting is not adequate alone. Pages vs texts - one is hospital approved and expected that officers will have on. Personal cell phones, not so much. I would page, because that actually creates a record of something your senior is responsible for seeing, however, if that gets no timely response, you should page again, and in anything serious you page AND call. Because again, one creates a record, and one is a more direct method of trying to track them down. Be sure your page makes the situation clear as being serious and send more than one to explain if you must. Send an overhead page if you can. If you can leave the patient, go physically track down your senior or attending if you must, if you can reasonably find them. Send a nurse if you can't leave bedside. If you have to, and I've done this, approach any attending that might reasonably offer assistance. I've grabbed a hospitalist that wasn't on the teaching service when it seemed like help just wasn't coming or wasn't coming fast enough. In the scenario with dosing, I've also ran something like that by anyone senior to me that could help - another senior in the room, an attending sitting next to me even if they weren't on my service. People expect interns to reach for a lifeline wherever they can get it. If it's not appropriate typically they'll help you find someone who should be helping you (assuming you tried already). It might be an annoyance but we all know that interns have to kick things up.