The patient continues to lie there, doing nothing more dramatic than setting off the yellow alarm by dropping his heart rate to 34. 

"Uhhh, second blood sugar was 39?" Grey Scrubs says uncertainly. "Should I be - trying to get another blood pressure -?" 

Yes, right, job to do. It's not even 10 pm and Nellie already feels like she desperately needs some Red Bull, possibly via central line, but she can do this. 

"Please." And she looks down, notices the two boxes with the syringes of 50% dextrose, and goes to ram those in FIRST - should totally be compatible with norepinephrine if she pushes it in fast and flushes, right - and she can deal with anything else LATER. 

Grey Scrubs looks up at her. "I got 90 over 30? Is that even a real blood pressure number?" 

The child who looks too young to even be a nurse yet is possibly not the best at manual blood pressure readings but even Nellie isn't going to say that out loud. 

"Look, kid, who the fuck knows. See if the monitor can get something–" 

The monitor is currently having unrelated complaints, and singing the song of its people about them. 

"- Okay I can't remember the exact thing I put in for atropine dosing but it's been more than five minutes for sure and I hate that number."

The patient's heart rate has just dropped to the mid-20s. 

"Yeah, okay, I'm not waiting a minute to see if he keeps this up. Where's the fucking atropine vial gotten to. Oh there. Go on and cycle the BP on the monitor again, though, might as well try." 

She's only halfway through the second ampoule of dextrose - it's thick, it doesn't push fast - but he's presumably been having bizarre blood sugar problems for a WHILE and it seems more urgent that he continue to have a pulse. 

This doesn't do that much but it gets his heart rate back above 30 and more regular? 

The monitor is still ruminating on its attempt at a blood pressure reading when the care aide runs into the room, triumphantly holding a large box in one hand and hefting two enormous bags of saline in the other. 

"I got it! The bladder irrigation stuff you wanted from uro-surgery, right?" 

"I could kiss you!" Nellie says fervently. "Don't worry, I won't actually. Go stick one of those bags in the microwave for me please. For, uh," how to math this, "- try five minutes and then slosh it a bunch and check it with your wrist like you'd do with a baby bottle?" 

The aide looks dubiously at her. 

"Look, this dumbass kid has a body temperature that usually kills people and we're trying to fix that. Just get it to, like, bath temperature. Please." 

The monitor bings plaintively, having finally made up its mind on a blood pressure reading of 86/39. 

Well, you know, that's not a blood pressure of 'dead'. Nellie's going to bop the norepinephrine drip higher just in case -

- though plausibly they should consider switching to a pure inotrope like dopamine, from her vague background knowledge Nellie thinks that hypothermia generally messes with cardiac function but tends to cause vasoconstriction by itself, which sure looks like what's happening based on the kid's mottled grey-blue hands and feet - she really shouldn't put that in as a verbal order without asking Dr Beckett though - honestly she wants Dr Zee's input here, but clearly no one has had time to even consider texting her - 

"We should put in a large bore gastric tube before X-ray gets here," she says to Grey Scrubs, very calmly. "I assume you're comfortable with that? Go find the biggest one you can, please." 

He gives her a skittish look and then hurries off to check the shelving full of supplies. 

Nellie rams in the rest of the dextrose and bumps the norepi drip up to 10 micrograms per minute - about half of the standard max dose, her old hospital did it weight-based and she thinks the local way is much worse for obese patients but this kid really, really isn't - and then she heads to the desk with the phone. 

And dials Staffing. 

She gets an automated voicemail, saying that the department closed at 9 pm. 

Hoooooooowwwww is it already after 9 pm. Shit on a pickle. 

After another ninety seconds of FRUSTRATION - which she spends mostly fuming about how she COULD be using this time to put a three-way Foley catheter in and get ready to provide internal rewarming to this dumbass kid as soon as the stupid aide gets back from the microwave mission - she has the on-call night shift manager on the phone. 

"Hi. Nellie from the ICU here. - Yes, I know I'm calling from the ER." Scowl. Pause. "I'm calling because you need to find us someone else to come in on nights. ....Yeah, no, I don't give a crap." Pause. "- I don't know what the acuity metrics at 7 pm have to do with anything, we just got two admits who almost tried to code at the same time and I'd be surprised if they don't throw that at us before tomorrow morning." 

She listens for a while. 

Looks pleased with herself. 

"- Thank you. 'preciate it. ...Uh, bless you too." 

The patient does not do anything exciting while supplies are being assembled. His heart rate goes irregular again while Nellie is putting in the three-way Foley catheter, but doesn't actually drop below 30.

...He does, however, do a nine-second pause while Grey Scrubs is in the middle of fiddling with trying to place an NG tube. 

Oh, right, that's probably a vagal stimulation thing. For fuck's sake. It hasn't been five minutes probably but Nellie still has the rest of the 1mg vial of atropine in her pocket along with a syringe and she can have that in his bloodstream within thirty seconds, by which point the excitement is clearly over. 

Grey Scrubs is still standing there looking sort of paralyzed. 

"- Hey," Nellie says quietly. "S'fine. I'll do it. He's fine, he's just being obnoxious. Why don't you go find me one of those Kangaroo gravity bags for tube feeds, and then go microwave a bucket of water. Tap water's fine." 

He gives her a very overwhelmed look. "Umm. Microwave it in what? I think the graduated measurement thingies might have BPA in them." 

Sigh. "Look, I don't care? Maybe it'll make him trans or whatever next year but it won't kill him, unlike the hypothermia, and also it's going to be in his stomach for like thirty seconds, that's the point. If you really wanted I guess you could steal the clinical educator's 'Best Mom' mug, that's at least 500 ccs and her office is unlocked." 

He scurries off. 

Nellie gets an orogastric tube down in about fifteen seconds, without causing any problems, though it presumably helps that she just gave the patient drugs that block parasympathetic nerve activity from affecting his heart. She's even pretty sure it's in the right place, because WOW it looks like this dumbass kid swallowed a lot of water. Probably should have done this sooner, actually, just to decompress his stomach and minimize the risk that he vomits again when they do anything to him.

She's going to hook the tube to one of the suction canisters for now - sure, she's about to pour a Best Mom mug's full of hot water down there but it'll work even better if it's not just mixing with gross swimming pool water.