Her help would be appreciated! It doesn't seem feasible to move the patient onto the ventilator when he's still satting at 85%, but bagging him is a two-handed job. 

With Marian's help, though, he can get nebulized albuterol hooked into the ventilator tubing! 

It...maybe does something. The atropine does more; a minute after it goes in, his heart rate is up in the 80s. Something still looks wonky with conduction, but at least some of the complexes have P waves. The next blood pressure reading is 101/68, which is entirely tolerable. And, maybe just because his lungs are perfusing better along with the rest of him, the SpO2 reading finally makes it above 90%. 

Despite the warming blanket and heated fluids, though, the next temperature Marian checks is actually down to 32.7 C. 

That's not ideal. It's not that surprising, though, probably they're just getting a bunch of cold blood returning from his extremities as his circulation improves. He's not that cold - they cool patients to that range on purpose for the therapeutic hypothermia protocol - and he should start warming up soon. 

(Marian still has a nagging niggling feeling that she's missing something, but 'something' is pretty likely to be a result on the pending tox screen, meaning she can't do anything about it by standing here staring at the patient.)  

"Uh, call the ICU if you get admit orders," she says. "We can probably send someone over for transport." And she smiles as reassuringly as she can at the kid and does her best to gesture 'stay here', it would be kind of awkward for her duckling to follow her all the way to the ICU and hover in her other patient's vicinity. 

She goes. 

Tsashi watches her go with mild wistfulness - it is, in fact, reassuring to have an adult look at her and smile at her and seem to be trying to tell her without words that Lionstar will be okay - but she's definitely being told not to follow this time.

She turns her eyes back to Lionstar, this time to investigate the thing in his mouth. She isn't sure what that's supposed to be doing. It takes another minute and a lot of repetitions before she pieces together that the woman doing something to the...whatever it even is...matches up with Lionstar's chest rising. 

That's so clever! It's sort of uncanny as well. Normally if someone is badly hurt or sick enough to struggle to breathe, they aren't going to survive - 

(She mostly isn't thinking about what happens if Lionstar dies. She probably should be. Lionstar would say that it's stupid not to plan for bad things that could happen. It's just...still hard to make her thoughts actually go there.) 

Somewhat unbelievably, it's only 10:25 pm when Marian gets back to the ICU. It felt like way more things than that happened. 

She finds Chantal at the nursing station. This would be awkward if she wasn't on the other side of embarrassment. "Uh, the code from the ER needs a bed here, probably. Dunno how long, the doctor sort of ran off for a page as soon as he was kind of stable. I can take him in 202, uh, if that's okay, I got report already." 

Chantal nods tersely. "Figured you would take the code if they needed a bed. It's either that or a transfer, but I can put the transfer in 196. - hmm, iso status?" 

Marian's brain briefly skips like a damaged CD. "...Uh. None that I know? He came in with lacerations and probable OD, hypothermic, I don't think there's any reason he needs isolation..." 

"Good," Chantal says, without explaining why she bothered to ask. "Annie can take the transfer, then." She's clearly busy, and spins her chair back around to the computer when Marian doesn't immediately say anything else. 

Okay. Right. Marian needs to get caught up on 201. And check the room, but cleaners are currently there, so. 201 first. That means she should...do things...that are not sitting in her chair staring into space and wondering what on earth is wrong with the John Doe admit and what country he and his maybe-daughter are from. 

Charting feels completely impossible so - stand up. 201 is isolation, droplet (pneumonia) and contact (known MRSA carrier.) She has a pile of midnight meds, which Marian can get a head start on prepping those before she commits to going into the room, and she can do an (early) assessment and turn (ideally with help but she has enough pillows to manage without, 201 isn't a huge lady), and that will probably take her to 11 pm and it's within-range to give q6h meds an hour early...

201 is intubated and sedated, rousable enough on a propofol drip to open her eyes and squeeze a hand but drowsy enough that she's unlikely to feel awkward if Marian doesn't bother with small talk the rest of the time. Which is a relief. Marian's brain is tired. 

By the time Marian makes it out of 201 at around 10:58 pm (she decided 10:52 was close enough to 11 pm to give meds early), her computer workstation has been taken over by the on-call resident, who smiles tiredly at Marian and rolls her chair back from the desk. 

"I picked you up a coffee," she says cheerfully. "Saw you're here all night. Tell me about your guy? There's not much in the chart." 

"Thank you." Marian finishes wadding up her disposable iso gown into the trash and detours to wash her hands at the corner sink before darting over to nab the coffee. She's almost embarrassingly glad to see Dr Sharma, and only about 30% because of the thoughtful delivery of caffeine. Dr Sharma is a third-year resident, and she's only been on ICU rotation for a few weeks but she really knows her stuff. 

"Right. Uh. There wouldn't be, we know, like, two facts about this guy and neither one is his name. We think he was assaulted - um, he definitely came in injured and bleeding, and there's a kid with him who doesn't speak any English or French but was, like, Charades-ing stuff for the EMTs. Suspect he also OD'd on something but that's a guess on symptoms and Charades-interpreting, so." Shrug. "They were both on the side of a road or something, so he's hypothermic from lying in a snowbank, the temp I got was like 33 C. Altered mental status when the ambulance arrived and he deteriorated from there and coded right when they got to the ER - uh, briefly, they basically had a pulse back by the time I even got there. He was in this weird slow ventricular-ish rhythm and epi barely did anything but he seemed to respond okay to atropine. He was also pretty hypoxic and hard to ventilate even once they intubated him, he might've aspirated and definitely had some sort of bronchospasm thing going on. They were waiting on tox screen results when I left. Plus everything else. Are his labs back yet?" 

"Only a really terrible iSTAT blood gas. I think the lab is still backed up. You'd hope putting the orders in stat would help, but." She shoves the chair back and stands. "I'd better go see. Is the room ready, if I think he needs to come over right away?" 

Dr Sharma is so efficient. Marian normally appreciates that, but right now she feels outpaced. "Um. I'm sure I can have the room ready by the time you get back." 

The room is clean and has a bed it in and everything! The bed has sheets! It still has a stolen extra bedside table from Marian's previous room setup. 

The cleaners have unsurprisingly not restocked anything except for basic linens. There are two clean gowns and plenty of towels and the soap dispenser is full, but most of the supply drawers are thoroughly depleted, and none of the wall suction hookups have canisters or tubing. 

UGH Marian should do something about that. It seems like a lot of effort, especially the drawers, she doesn't actually have a complete mental inventory of what's supposed to go where. If it could have waited until midnight then the night shift personal support worker could do this room first on their restocking run, but, unfortunately. 

Suction supplies first, because the patient is probably going to show up with an ongoing saliva disaster, and once that's done she can spend some time staring at the clean utility room shelves and figure out what she most desperately wants to have on hand for tonight... 

Chantal sticks her head into the room five minutes later, while Marian is shoving prefilled saline syringes into a drawer. "Sharma just called. Wants to know if you'll meet her at l'urgence." 

Oh no. That's not reassuring. "I can go. Did she say why?"

...Clearly not. Marian is going to run. 

It's not obvious from the scene greeting her whether it's, in fact, an emergency? The kid is still hovering. Dr Sharma is in the process of donning gloves; she doesn't look particularly stressed, but she tends not to show it even in active emergencies. 

The patient's vital signs look...vaguely tolerable, at least. He's on the ventilator now and the volumes it's getting for each breath look low, but his O2 saturation is hanging on at 90%, heart rate in the low fifties, and the last blood pressure up is an acceptable 94/55. 

Dr Sharma spots Marian. "Oh good, thanks for coming. I want to give him activated charcoal, in case he ingested something toxic. - that's not what I need you for, Pat is getting it. He had a watery bowel movement and I don't want to transport him lying in it. Can you help me get him on clean linens?" 

"- Yeah, of course." Marian appreciates Dr Sharma so much. She can count on one hand the number of residents who'll jump in themselves to help clean a patient up. 

She brings over an armful of linens. Smiles at the kid, then frowns as Dr Sharma folds the Bair Hugger blanket out of the way. "...Wow, okay, that's a lot. I'm just, uh, going to put some towels down before we try turning him..." Marian isn't particularly grossed out by diarrhea, but someone did a really nice job of the abdominal dressing and it would be tragic if it immediately got soiled when they rolled the patient into his own shit. 

(She feels surprisingly self-conscious about the twelve-year-old intently watching their every move. It feels like kids really do not need to see their...parents? uncles? whatever...in this particular situation.) 

She lowers the bedrail out of the way. "Want to turn and I'll wipe?" She's wondering if diarrhea is a known side effect of some particular drug. It's not leaping to mind. GI side effects are pretty non-specific. 

Dr Sharma is less used to moving patients than most nurses, and Marian has to awkwardly dive in and straighten out the IV tubing before she accidentally yanks on it. 

Which means it takes her a couple of seconds longer than it might otherwise to notice that the patient is, apparently, NOT a fan of being turned on his side. The ventilator high pressure alarm goes off, the breath volumes on the display immediately dropping to a minuscule 200 ml, and a few seconds after that the monitor alarm starts going.

It's not actually his sats, which haven't started dropping yet. His heart rate is abruptly dropping into the 30s. 

"Shit!" Marian's brain is not really coming up with a more coherent response than that.

"Hmm?" Dr Sharma glances at the monitor, then frowns and gently releases the patient onto his back again. "That looks like a parasympathetic response, maybe? I think he had a standing order for atropine, can you check when he last got it and pull some if it's been long enough?" 

She leans in to tap the monitor control and cycle the blood pressure reading.