Why does the syringe she just squirted out into the nearest garbage can kind of smell like the beach. No beaches were involved. 

Eh, whatever, she can worry about that later. Tube goes to suction canister. 

By the time the X-ray technician arrives, there are 300 ccs of cloudy stomach contents in the suction canister, and a 3L bag of approximately-warm-bath-temperature saline hanging precariously from an IV pole and hooked up to one lumen of the patient's fancy catheter, which is draining into the special enormous floppy extra-capacity catheter bag that comes with the kit. There is also, perhaps inexplicably from their perspective, an enormous, faintly steaming ceramic coffee mug with 'Best Mom' next to a picture of a unicorn and a rainbow, sitting on the bedside table alongside a pile of miscellaneous supplies. 

...Whatever, it's hardly the weirdest thing he's ever seen on night shift. "X-ray?" 

"Yep!" Grumpy squint at the monitor, which is back to a heart rate of 32 and seems to have fallen into a pattern of two or three regular beats, a wide-complex ventricular beat, and then a two-second pause. "....Wait one sec though, gotta give this guy some atropine first. He does screwy shit when we move him. Or do anything to him." 

Perhaps due to the proactive premedication, their patient does not do anything exciting while they reposition him mostly sitting up for the X-ray and get the board in place behind his back, stuffing some pillows to stop him from toppling sideways. 

In fact, he doesn't do anything exciting until afterward, when they're pulling the board out, and the X-ray tech misjudges the manual controls on the ancient gurney and drops him from 45-degrees to flat with a thump. 

The patient startles visibly, tenses, and starts reaching for his breathing tube. There are restraints on his wrists, but not actually fastened to anything. 

ARE YOU SERIOUS???? 

Nellie lunges for him, and fortunately he's not very competent at moving his arms; he mostly manages to bang one elbow into the rail. 

Now that he's done being startled, he goes limp again, apparently lapsing back into unconsciousness. 

Kid's temp is TWENTY FUCKING SEVEN DEGREES how is his brain capable of functioning at all!!! Fine, the propofol he got on the scene with the paramedics was probably an hour ago and he's not on any ongoing sedation, but STILL! 

...On consideration, she hasn't actually been re-checking his temperature. Because - why - right, because she looked around for fifteen seconds and didn't see a cable to hook the stupid rectal probe to the monitor and then completely forgot. She will go look right now. 

- scratch that, she will tie the restraints down and start some midazolam - just at 1 mg/h, it's not like he's agitated at baseline - and then she will worry about finding the right cables. And calling Dr Beckett to get official go-ahead for the OG tube, though she's pretty sure from her own glance at the screen and also all the stuff they got out of it that it's in the right place. 

The patient does not do anything else concerning while she's working on this. 

The monitor eventually declares that his core temperature is up to a whopping 28.2 degrees centigrade. 

That is ALMOST A WHOLE DEGREE Nellie is DELIGHTED. 

There's a long way to go, of course, and the next few hours are the riskiest - and with their luck, they'll get him through that only for him to slowly die over the next week as his lungs stop working. But if they can get him through the acute ARDS, this degree of hypothermia is - maybe actually good for his eventual prognosis? Even with some hypoxia, the cold and reduced metabolism would have protected his brain. 

She's about to call Dr Beckett when the phone rings. 

It's Chantal. 

"Is Nellie still there? Need to talk to her." 

"It's me. I hope you're calling to say I can head over!" 

"...The room's ready. But I'm calling you because we've got some issues and I need to reshuffle the assignments." 

Sigh. "What - oh, is it that you don't want to give Loren the shitshow rave girl? Fair enough, I guess. I...don't really want to give Loren this guy either, though." 

"Isobel's willing to take her if she can be 1:1, it's looking from initial labs like we may need to start her on dialysis before the am, she's threatening some multi-system organ failure on us. But I just got a call from the manager and Rick's willing to come in at 11:30. ...On the downside I think we may be getting a third admit. Do you think there's any possible way you could hand off your patients - I can take one, Loren can take the other since she's not getting 196 after all - and then take your guy in the ER and also Ma'ar?" 

Nellie's first, absurd thought is that Marian will be so relieved she doesn't have to take report from Isobel. "Hmm? Yeah, sure, of course. I know Ma'ar, that's totally fine. I'm glad staffing listened to me, I called and had an argument about it." 

"You did? Wasn't sure if it was just because I had updated the acuity scoring. It did seem more proactive than they usually are!" 

"You're welcome. Honestly, this dumbass kid should maybe be 1:1 but I think I'm just going to text Dr Zee for advice, I have standing permission to do that." And she should actually DO it before it's past a sane person's bedtime. It's just that things keep happening. 

- in fact, another thing is happening now. The phone is ringing on the other line. It says LABORAT– (the screen size generally cuts off the second half of long words). 

"Is that all? Gotta go, might be critical results on my patient calling." 

"Yes, of course. Try to get over here soon so we can do the handoffs and switching around." 

Great. Trekking to the ICU was a better proposition when it didn't mean she also had to take over responsibility for Ma'ar. Damn, she should really have asked Chantal about getting him an overnight sitter. She can and will drug him to the gills if that's what she needs to do to keep him safe while she handles dumbass kid here, but Marian will be so sad if she comes in (Marian is definitely getting Ma'ar back, Nellie will make sure of that) and it takes him half the day to wake up. 

She answers the phone. 

They sure do have some abnormal lab results for her! 

Sodium: 156, critically high. 

Chloride: 121, critically high. 

Potassium: 2.9, low though not critical. 

Phosphate: 2.1, low but not quite critical. 

Magnesium: 1.3, also low but not critical. 

Lactate: 6.1, extremely alarming. 

Blood gas, venous: PvO2 25, PvCO2 65, bicarbonate 15, pH 6.98. 

Oh and also his hematocrit is really high, which would usually indicate dehydration; they don't actually have a 'critical' top range because this is never really an issue, but it's, like, pretty damned high. 

What in the name of the Father the Son and the Holy Ghost - 

Maybe if - 

....Nope, she's got nothing actually. 

Nellie thanks the lab tech and then sits at the computer and refreshes the screen until the new lab results pop up, in case staring at them will make any more sense of it. It doesn't. 

She takes a photo on her smartphone and texts it to Dr Zee. 

[Near-drowning. Supposedly campus swimming pool]

[Looks sick as hell. Temp under 28 C. Keeps bradying down to 20s & 10 sec pauses. Latest labs here] 

[Also randomly hypoglycemic???] 

[Please tell me something here makes sense to you]