"Down to 36, yeah, give that here." Nellie snatches the D50 box and rips it open. Pauses very briefly to frown at the pile of drugs on the table. "We're doing oral potassium? I bet you a coffee he's going to barf. Poison control said don't bother on the activated charcoal?" 

"Not taking that bet." Marian sticks her head behind the pillar. Oh, good, there's still a tree of IV pumps hiding back there. She pulls it out. "Uh, shit, we could use more IV access - maybe I should try for another peripheral, I don't know when Dr Sharma will actually have a chance to do a central line..." 

The patient's skin is notably clammy to the touch, but he makes it surprisingly feasible to find a vein, for someone with a systolic blood pressure currently in the low 90s and a body temperature below 32 C. He's really not carrying much subcutaneous fat, but he's clearly very fit, with wiry muscles. Marian is able to get a 20G IV in his wrist without too much trouble, and prime a new saline primary line to hook up the magnesium to in piggyback. 

(This is around the point when Louis-Philipe finally arrives with the Bair Hugger.) 

The patient responds a little more to a 6mg dose of atropine. His heart rate jumps to nearly 80, and the next blood pressure reading is 112/81. 

Nellie, having given the dextrose and atropine, is now pausing briefly to listen to the patient's lungs. "...God, he's still drowning in secretions. He's on other pressors? ...Why is he on dopamine and norepi, weird. I'm going down on the dopamine, think we're going to have to give him a lot more atropine to get his lungs under control and I don't want to overstimulate his heart." 

Magnesium is running, good. Still waiting for the X-ray tech to show up... Marian will take another blood sugar. 

53 mg/dL. 

At least it's headed in the right direction? Probably she doesn't strictly speaking need to bother Dr Sharma for a repeat order and can just...give him another amp of D50... 

By the time Dr Sharma actually makes it to the room another five minutes later, the X-ray tech has come and gone, and Nellie has the raw image up on the computer screen (where the kid is peering curiously at it.) 

It takes her about four seconds to confirm that the tube is in the right place. "Go ahead with potassium. How's he doing?"

O2 sats at 94%, which isn't incredibly impressive on 100% oxygen but is at least tolerable. Heart rate at 86, last blood pressure 108/79. 

Marian is rechecking his blood pressure yet again. "I, uh, ended up giving him three amps of D50. Repeat sugars were 53 and 66. I don't know where he's putting it all but I think it's helping." The patient's color is a little better, and it's early to say - and hard to know how much is the Bair Hugger - but he might be managing to produce more body heat. He's now back up to 32.2 C. 

"Heart rate's improving but he's still pretty wheezy and wet. Try a higher dose of atropine?" 

"It's been more than five minutes? Yeah, let's try 10 mg next – and grab enough to step up to 20 in another five minutes if he's still wet, we're apparently supposed to just keep going up until his respiratory status improves."

She makes a face. "We really shouldn't be running pressors in a peripheral, but I'm pretty nervous about dropping a line in him before we've corrected his lytes. I'll do an art line, and - hmm, maybe if we're lucky the atropine will let us wean him off the pressors..." 

Marian is just going to hurry off and see if the Pyxis lets her take out six ampoules of atropine without throwing a fit about what the hell she's thinking– oh, right, she should ask about fluids. "Uh, did we want to give him another bolus? He's still pretty cold, we can do it heated -"  

"Yes, definitely, thanks for reminding me." Dr Sharma turns back to Nellie. "You're right, we'll want to start pralidoxime - only once we've hit adequate dosing for atropine, or it can make things worse, but we'll want it ready to go. Protocol is a 2g loading dose over 30 min and then 1g/hour for at least the next 24h and reassess, but probably keep it up for a full 48h. And I need to call the General, our lab doesn't do the diagnostic test we want to confirm it, but you're right that we need to draw that before we start the pralidoxime..." 

Tsashi is wishing desperately that she could understand what anyone was saying! The Healers are definitely doing lots of things in a hurry. They seem calmer, though, there are no more raised voices and the expressions are stressed but not surprised. Her guess is that something was wrong with Lionstar that they weren't expecting, but now they're deciding what to do to help him, and nothing more surprising happened? Which seems...good, probably...but she wishes she knew for sure. 

She slips her hand into Lionstar's. She's a bit worried that he's going to wake up and be very confused and upset. 

Marian comes back a couple of minutes later with pockets full of atropine and a freshly warmed bag of saline to slap into the pressure bag. Awww, the kid is being cute. ...Which is actually weirdly upsetting to watch, probably because it's nearly midnight all of a sudden and Marian is tired and undercaffeinated and hasn't sat down or eaten in way too long. 

The higher dose of atropine almost-instantly spikes the patient's heart rate to 120. The effect on his lungs is less marked and slower to kick in, but it does look like the breath volumes on the ventilator are rising. His sats creep up to 96%. 

Nellie puts the dopamine pump on standby. "I think we can get him off pressors. I'll have another go at suctioning him, maybe now he'll tolerate it long enough to actually get him cleaned out." 

...Oh right Marian was supposed to be checking a repeat blood sugar. She forgot to actually look at the glucometer and now the screen is turned off. Maybe if she pokes it, it'll turn back rather than resetting entirely...? 

- yep, good, 81 mg/dL. "Uh, Dr Sharma, his sugar is back up but it's not, like, super high? I kind of want to recheck hourly," until they have some idea WHY it was so low, she's still at a loss. 

"Yeah, sure," Dr Sharma says distractedly, leaning in to examine the lung secretions now emerging from the suction tubing. "...Wow, he really is wet. I want to have a listen once you're ready to give him a break -?" 

Pause. Nellie silences the ventilator alarm again, checks the sats on the monitor - down to 91% - and goes in for another pass. "Euuggh. ...That might be a bit less, we're making some progress." 

Once Nellie finally does give the patient a break - less because she thinks his lungs are cleared out and more because his sats are still dropping and down to 87% - Dr Sharma swings down her stethoscope to listen to his lungs.

"We're getting better air volumes and lower peak pressures, I think that's a good sign on the bronchospasm? But he's still sounding pretty tight. Marian, go ahead and prep 20 to give in, hmmm, three minutes. And I want some repeat labs, ABG and lactate, but we need the art line anyway, it can wait for that." She glances between them. "...You both look busy. I'll prep the tray." 

Nellie sniffs the air, scowls, and lifts the edge of the Bair Hugger blanket. "- Definitely busy. Dr Sharma, do you want maintenance fluids? Poor guy's losing a bunch of fluids out the back end. - Marian, I'll go get stuff to clean him up, we'll want to do it after he's atropine'd." 

Which leaves Marian abruptly alone with the kid in her patient's room, with two minutes to go until she's supposed to push the syringe of drugs in her hand. 

...He's still sticky with sweat, and drooling, making an unpleasant mix with all the grime around his face and neck. Marian puts her syringe down on the bedside table beside the four empty ampoules, and gets out a small washcloth from the conveniently stocked drawer to wet at the sink and wipe him down a bit. 

The patient hasn't shown any visible sign of responsiveness to anything up until this point, at least not in front of Marian, but apparently having his face washed is particularly stimulating! He grimaces faintly, his forehead scrunching.