"Mmm, sure?" 

It's 7:05. As the minutes tick forward to 7:15, various things happen. The respiratory therapist belatedly arrives, obtains a blood gas sample, and asks Emmy if she wants a ventilator set up here or to wait. Emmy, who's been manually ventilating the patient this entire time and almost forgot she was doing it, shrugs and says they might as well set it up on the ICU end. Matt pushes an ampule of bicarbonate and spends a couple of minutes googling the effects of significant hypothermia on how well epinephrine works, but by the time he's concluded that it's "probably fine", the patient's blood pressure is struggling back up toward something tolerable. Matt, on Marian's suggestion, also hunts for and digs out the neonatal O2 sat probe, which wraps and sticks on like a bandage and, while it's meant to go on babies' tiny feet, also works surprisingly well on adult earlobes. This gets them an easily-disrupted but much more robust waveform, and a number very solidly at 100%. In hindsight, probably manually bagging the guy with 100% oxygen is overkill. 

Marian hunts for veins. 

She's not, actually, all that good at IVs. But she's often a lot more patient than busy ER nurses are willing to be. 

She gets an instant heat pack, cracks it open, and heat-packs the patient's forearm, below the existing IV. She flips down the railing and unties his wrist - keeping a careful eye on him - and lets his arm dangle off the side of the bed. She only ties the tourniquet in place after a minute of that, and gets out her penlight for extra vein visibility. 

There, that one on the side of the wrist, she can probably get a small 22G needle in there... 

Ma'ar is oblivious to these manipulations. He's trying to breathe a little on his own, now, occasionally fighting with Emmy's timing for squeezing the bag, but that's the only change. 

Marian heat-packs the vein some more while she preps materials, makes sure the lighting is good, reties the tourniquet, swabs his skin... 

...if she misses it then they're kind of screwed. Practicing every opportunity she can get is all good, until the stakes are 'maybe her patient dies.'

Marian swallows her pride and straightens up. "Patricia? Are you good at IVs? I found a vein but I'm - not sure I can get it." 

Patricia has a go. It's a lot easier now that his blood pressure is back up above 100 systolic and he's also, conveniently, totally out and holding still for it. 

7:14 am. Marian is thinking sadly that she missed her chance for a no-line wait at Tim Hortons, at least until after 9 am when the rush quiets down. And she's going to miss shift report too. Probably someone got the message that it's because she's trapped in the ER with an admit? 

...They'd better let her keep this patient. Marian is feeling kind of possessive. 

Without an obvious next action, Marian putters. She transfers the norepi pump to the gurney's pole for easier transport, programs it properly, and then hunts down another pump and primes a bag of saline so she can hang the electrolyte replacement in piggyback. (Can you run mag and phos in the same IV? She actually has no idea, she'll have to look it up.) 

Matt ducks off for shift report and huddle, but returns thirty seconds later with two plump little bags, neatly labeled for John Doe, supposedly born on Jan 1st 1900 is that some kind of default setting. 

The phone rings. 

Marian answers it, since Dr Beckett is still breathing for their patient. 

She bounces. "Room's assigned! We can head over! ...I don't really want to wait for transport, do you?" 

"Oh, phew. No, I don't. I do want a syringe of epi in my pocket. Just for my peace of mind." 

"It's, like, thirty seconds down the hallway," Marian points out, but lets it slide. "I'll find us an oxygen tank. Might as well start the phos and mag once we're there." 

And then they're underway. Packaged fairly neatly for transport, the oxygen tank lying beside the patient's legs. Marian takes the handles of the gurney, and Dr Beckett holds the ambu bag and grips the railing to help steer. 

...She doesn't have her badge. Oops. Also, Marian only just remembered that she meant to put deodorant on. After removing her sparkly red sleeves. And then she was interrupted. She just did all of that in her party outfit... 

"I got it," and Emmy swipes them in and taps the wheelchair-access button. 

There's a room. The lights are on in it. There's even suction set up properly.

There is not...a bed. 

This was not a problem Marian was expecting and, pre-caffeine, it sort of sends her brain into a tailspin. "Um," she says to no one in particular. 

"That's awkward. We'll have to...call supply and order one, I guess? Does central supply do beds? Don't worry about it, just get him settled, I'll go ask the charge nurse to deal with it." 

Getting her John Doe transferred from the portable monitor brick - it pops right out of the ER monitor and has a teensy screen of its own - onto the ICU system, is a pain. Mostly because she has to count to ten in her head repeatedly and remember to squeeze the ambu bag; he's breathing spontaneously now, but not that often. She gets a new blood pressure - it's actually up a bit, 110/70, maybe the jostling did it - and checks that his sats are still 100%. 

And then, because she is an idiot, she spends nearly a minute waiting for the thermometer to read, and stares stupidly at it when it times out and settles on LO. She didn't think to grab the one that the ER was using and she's not sure if the ICU has its own. 

...no, wait, she is triply an idiot, she brought the fancy catheter for exactly that reason. Unless she left it behind, that would be - kind of hilarious in a mortifying way - but no, it's there, stuffed at the foot of the gurney where she must have dropped it. Right, she left the Bair Hugger machine behind, she'll need to grab a new one - should she heat up his phosphate and magnesium bags, are they going in fast enough to matter either way, is it even safe to do that - can she put them in the IV bag - damn it she forgot to ventilate the patient for the last thirty seconds, his sats don't seem to have noticed but still. 

One thing at a time. She will call RT and get them to do their JOB and then she will check med compatibility and hang the mag and phos and then she will place a catheter and THEN she can retrieve the Bair Hugger. Or hopefully at some point someone else will show up and she can delegate. Shift change is such an awkward time. 

More hands thankfully arrive soon, in the form of RT and Anne-Marie, a fellow new grad, who agrees to grab the blanket-warmer machine. 

Anne-Marie also has a much more sensitive nose. She sniffs. "...I smell pee." 

Marian lifts the deflated blanket. 

"...Oh. Awkward. Uh, can you get me another blanket pack too, this one's... Gross. And, uh, a towel. Maybe two towels." She is slightly wishing that someone had made different choices early about when to place a catheter, though it was admittedly less urgent than many other things. She's guessing he lost bladder control when he nearly coded, and no one was expecting that.

Anyway, whatever, they're waiting on an actual bed, she'll just sort of sop it up for now instead of trying to change sheets on the gurney. 

Her patient, at least, has the excellent qualifications of being: 
- not ancient 
- not obese
- not a woman
- not struggling wildly 

Finding the right cable to hook into the monitor and the other end of the temp probe is actually more time-consuming than the placement itself, but after that she has a NUMBER right there on her SCREEN. Which immediately sets off the alarm because she didn't think to customize the settings. 

It's a better number though! An entire 31.8 degrees! She could dance. Now they just need to get him blanketed again before they lose ground they've gained here... 

He's starting to shiver again, presumably as the sedation wears off. His pupils, under Marian's penlight, are equal-sized and only a little bit sluggish to react. He very weakly tries to pull his arm away when she pinches his nailbed, though neither that nor politely asking gets him to open his eyes. 

She is going to do an ASSESSMENT no nevermind she is going to make a very hasty trip to the staffroom to collect her stethoscope and - while no one is looking - skin out of her stupid shirt. On top of looking absurd, it's too hot. 

By the time she gets back, Dr Beckett and the day shift charge nurse, Amélie, are wrestling a full-size ICU bed through the door. 

"Marian? What happened to the warming blanket?" 

"Uh." 'It got peed on' feels weirdly like maligning her patient, even though it's literally what happened. "Anne-Marie's getting the machine from the ER and bringing a clean one. ...If we're going to transfer him, can we get him on something for sedation first, that would be really bad timing for him to wake up and freak out."  

"It really would be! Are we still maxed on the norepi, though?" 

"For now, I might be able to come down." Marian cycles the blood pressure, then remembers to switch it to every 5 minutes. It won't drive him up the wall right now, when he's unconscious; if his BP keeps being this all over the place, though, she should remember to nag about an arterial line. 

She squints at the number. 105/52. "C'mon, buddy, you can do better than that. I can probably come down a tiny bit?" 

"Don't. Let's put him on midaz, he didn't tank nearly so hard when he got that before. We can start it at, like, 1 mg an hour, I want to go gentle on him - if he's agitated you can bolus 0.5 mg, let's say q30min and bother me later if that's not enough, and up the drip to a max of...I'm going to put down 3mg an hour, we can reassess later but I really don't want to oversedate him right now when he's got so little cardiovascular reserve. He scared the piss out of me earlier." 

"He scared the piss out of himself too," Marian says before she can stop herself, and then feels her cheeks turning crimson. "Um."