The crowd of people around the patient is now down to only eight or so. Someone seems to have succeeded at getting an IV, and there's a 1L bolus hanging in a pressure bag. The rhythm on the monitor still looks bizarre, with wide ventricular complexes and no sign of P waves, but the rate is up to 49 bpm. The SpO2 reading on the monitor is showing a bumpy line that isn't particularly a waveform, and reading 62% with a question mark. The blood pressure cuff is cycling again. 

The attending doctor has the ultrasound machine, and seems to be attempting a quick bedside echo. 

A few seconds later, the blood pressure reading appears, this time settling with more confidence at 62/44. The nurse standing by the patient's head makes a face and whacks the monitor to cycle it again. 

That looks like probably they gave him epi and it's doing something and not doing nearly as much as you would hope. Hopefully it was like thirty seconds ago and is still kicking in? 

And the guy's cardiac conduction seems pretty fucked. Are there street drugs that do that? Cocaine and stuff can cause rapid arrhythmias but this looks like something different. 

There's a window of space beside the patient's head on the other side of the gurney. Rather than interrupting anyone out loud, Marian is just going to quietly sidle in and try to get an oral temperature. 

The low-temperature thermometer tends to take nearly a minute to pop up a reading. There's a new blood pressure, now up to 67/49, well before Marian gets a reading. The patient's heart rate is actually dropping again, now at 46. The SpO2 reading is still extremely dubious, and still in the 60s. 

Ughhhhhhh. Marian would usually assume the low reading was just fake, given that it's clearly not picking up on a pulse waveform, but this guy looks awful and she's not, actually, feeling very confident that just because he's intubated and the RT is bagging him with 100% oxygen means he's getting enough air. 

She has two spare NICU sat probes in her pocket, which work fine on adult earlobes and have better luck than the finger probes for patients in severe shock. It's been that kind of week in the ICU. She can prop the thermometer in place with her forearm and try to fiddle one of them onto the patient while she waits for the temperature reading. 

"Let's try 1 mg atropine," the attending doctor says absently, focused on the ultrasound screen. "See if that gets a better response than the epi. We noted pinpoint pupils, right – did he get Narcan in the ambulance...?" 

No one else is answering?? Oh right that's probably because Marian is the one who actually talked to the paramedic. She clears her throat. "They didn't mention it in the report."

"Right. Let's try that, then." To the respiratory therapist, "- you mentioned a lot of airway resistance, do we figure he aspirated?" 

     "...Maybe. Heavy secretions on suctioning, but it looked clear. I'll have another go -" 

"Atropine 1mg, going in now -" 

The thermometer finally settles on a reading of 33.1 C. Low but not disastrously so. 

Unsurprisingly, the sat probe does have an easier time of things on the patient's ear than on his finger. It's picking up on a straggly waveform matching the ECG heart rate. A few seconds after that, it settles on a reading of 79%. 

The respiratory therapist notices the new reading and nods in acknowledgement to Marian, then catches the doctor's eye and makes an unhappy shrugging motion without using her hands, both of which are occupied. "He's pretty hard to bag. Copious secretions, but still clear. Watery. He's hard to suction too. Honestly, it feels like bronchospasm, not so much aspiration." 

     Frowning. "Huh. Well, the epi should start to help, and the atropine might once it hits him. - let's get a stat chest X-ray, we'll need that anyway for tube placement. And might as well try some albuterol nebs when you have a chance." 

Probably a normal sane person would be more upset about the patient's abnormal vital signs than the saliva disaster. It's just that the saliva disaster is pretty salient to Marian, who had to interact with the patient's mouth to get a temperature. It's really not the top priority, right now, it's just that it's still bothering her. 

...The guy doesn't have much of a cough or gag reflex, she thinks vaguely, he barely twitched when he was being suctioned. She knows what the RT means about patients with bronchospasm being hard to suction, they've had two young people with asthma exacerbations in the ICU since Christmas, but usually they cough like crazy. 

The guy is pretty sweaty, too, which is a thing for patients in shock but it really can't be helping with his low body temperature. ...Which isn't on the monitor, right. She should probably...say something...about it. 

Marian clears her throat. "Uh, he's hypothermic. 33 C." 

"Mmm." The doctor does not sound like he really considers this his top priority. "Warming blanket, I guess. And the next bolus should probably be warmed." 

"I can get that." Marian peers at the pressure bag. It looks like the first liter of fluids are mostly in, but she can't actually see the label on the bag. "Uh, normal saline or Ringer's?" 

Shrug. "Saline's fine." To one of the other nurses, "tox screen's sent? Someone make sure it's not sitting at the nursing station, please, I want to know what the hell this man took. And let's get a blood gas, please. On the iSTAT, I'd rather not wait to know if he needs bicarb -" 

All of which is interesting and none of which is Marian's job right now. She doesn't really want to put the low-temp thermometer back without, uh, cleaning it, and they'll probably need it again anyway; she'll stick it on the least bedside table, all three seem to be nearby. And then head for the utility room to see if the ER actually has one of the Bair Hugger machines in stock right now or if she'll have to trek back to the ICU for it. 

She glances back to smile at the kid, who seemed like she might find it less upsetting and traumatic to follow Marian around like a duckling rather than standing there staring at her...father? uncle? they don't look incredibly alike, she isn't sure...who currently looks like he's several minutes away from dying. At least to Marian. She's not sure how obvious things like that are to smart but presumably not-medically-trained twelve-year-olds. 

...Yeah, she'll follow and try to learn more about where they are. It seems important and more useful than hovering while foreign Healers do things. Lionstar would want to be oriented if he wasn't so badly hurt. He's obviously in bad shape right now, but he's very very tough and the foreign Healers clearly have all sorts of advanced magic and Tsashi is actually less scared for him than she was before. And maybe they aren't friendly - Lionstar would definitely be paranoid - but Lionstar is honestly too paranoid about whether people are friendly, he even admits it sometimes. And it would be pretty weird of them to pretend to want to help until Tsashi turns her back. Since Tsashi is half their size and they don't know she has a weapon. 

Great! They can go on a hurried tour around the ER, then, and end up in the brightly-lit utility room, where to Marian's relief one of the Bair Hugger machines is tucked in a corner. 

There's so much stuff! Tsashi has never seen so much stuff in one place and wouldn't have been able to imagine it before today! There's an entire shelf full of...bags of water? Tsashi stares at them curiously and then pokes one to see what it feels like. 

It would prooooobably be better if the kid didn't touch things, but given that she can't just politely ask, Marian is not actually sure how to convey that without seeming angry, which wouldn't be fair to the kid. She'll just collect one of the disposable warming blankets in its plastic sheath and hustle the Bair Hugger machine toward the door as fast as possible. ...and dart back to grab a 1L bag of saline, right. 

The kid is enthralled by the microwave! She stares at it in abject fascination, but does seem to get the gist of Marian's frantic awkward hand gestures, and doesn't try to poke it while it's microwaving the bag of saline. 

Awww. The mysterious non-English-speaking kid is cute. And...kind of looks like she's never seen a microwave before? Where is she from? 

Marian gives the bag a good shake to make sure it's evenly mixed before gauging the temperature against her wrist and judging that it's probably in the general vicinity of 37 C. She wonders if the ear thermometer would work on it. Probably it doesn't matter that much, it's not going to burn the patient. 

She sticks the saline bag in the front pocket of her scrubs - ooh, that feels really soothing actually, like a hot-water bottle - and manages to free up enough hands to wrestle the Bair Hugger through the nursing station and back to the trauma bay. 

The patient looks...a little better, actually! Not just his vital signs - heart rate up to 58 and more regular, latest blood pressure an entire 82/60 - but the gestalt sense Marian gets from him. His color isn't good, but it's much less several-minutes-from-dying. 

The SpO2 reading is still only at 83%. The respiratory therapist seems to be having an effortful time bagging him. 

What is UP with this patient. Marian's brain is at this point screaming at her that they're missing something. Maybe he's having an anaphylactic reaction to drugs? Only in that case you'd really think that epinephrine would have more of an effect. And anaphylaxis doesn't cause delayed conduction, or whatever it is he has going on, his rhythm on the monitor still looks ventricular even though it's now an almost-normal heart rate. 

...Focus. He has circulation right now and sats of 83% aren't great but aren't "imminently about to code" low, and probably the RT is on top of that. Marian's current task is to get the new IV bag hung and the Bair Hugger set up. 

Tsashi watches with rapt fascination, her eyes following the clear soft string going from the strange clear waterskin to Lionstar's arm. It's...hollow, she thinks? And they're using it to put water into his body? That's so clever! She wouldn't really have expected it to work but it's brilliant if it does. Tsashi isn't one of the children who Lionstar taught much about Healing, but she knows that people who were injured and bleeding need to eat and drink to regain their strength. 

She's worried about the Changegoat poison. Tsashi has no idea what you do about poisons; that's more advanced Healing lore than Lionstar taught her. In practice, in the village, usually the answer is that you make sure the person rests and drinks enough water, and hope for the best. And usually they die. But maybe Healers with powerful magic from before the Cataclysm can do things? 

She looks at the bright boxes again. She's pretty sure they have writing on them, in a different language. And...pictures, of some kind, but she doesn't know what they're pictures of. Maybe this is how Healing-Sight works? She stares intently at the wavy line, wondering what it's a picture of. 

The doctor frowns at the monitor. Then at his beeping pager. "...Let's bump him with another 2mg atropine, he did respond a little. If that helps you can repeat it q30minutes. I need to go answer this. Call me."

His eyes focus briefly on Marian. "ICU, right? Find out if there's a bed available." 

There's definitely a bed available, in 202. Maybe 188 or 196 too, if they haven't already been assigned to a different admission.

Marian...kind of wants this patient to be her admit? Which is probably committing herself to an intensely exhausting night, but - well, she's going to get an admit one way or another for sure, and at least she already has context here. And the kid is sweet. 

The crowd of people who assembled for the code has dispersed even more by now; they're down to two nurses, one of them now hurrying to pull atropine properly from the Pyxis rather than taking two more of the premixed 1mg syringes from the crash cart, plus the RT still bagging the patient. 

Marian shuffles her feet. The kid being cute and sad and apparently now Marian's duckling is not a reason she can justify hovering here for the next who-knows-how-long until admission orders actually happen. The patient still being unstable might be, but he's at least less unstable than earlier, and taking an admission will be less of a disaster if she can grab the narrow window to get caught up with her patient in 201 first. Maaaaybe she'll stay until they find out if the atropine actually helps? 

She fidgets. "I...should probably get back to the ICU soon and check we're ready for the admit. Uh, should I help with anything else while I'm here - do you need me to pull nebs for you, you look kind of busy -?" And Marian does know how to prep the nebulized bronchodilator treatment herself.