Shit's about to get real guys... Stay strong and send a review please!

Chapter 10

17.30 - Sonia and Erin sat next to Tegan's bed, neither of them talking. Something started beeping fast , the sound of an alarm…. Sonia was startled by it, she looked at the monitor that now had the word "alarm" flashing on the screen and then at Tegan who's breathing was even more shallow and rapid. "We need help in here" screamed Erin out the door. Immediately a resident and a nurse came rushing into the room. A good looking female doctor took her stethoscope and listened to Tegan's heart while the nurse looked at the monitors. "Page Morgan – her temps spiking and she's tacky" A minute later Kate came rushing into the room. "Talk to me guys" she exclaimed "I'm having trouble managing the arrhythmias" said Dr Altman, the cardiology resident. Kate stared at the monitor and shouted orders "... and I need a rectal temp guys" They rolled Tegan onto her side and inserted a thermometer into her rectum. "104" said the intern sounding panicked. "She's spiking fast said Karev." For the next hour they struggled to keep Tegan's heart beating in a normal rhythm and to keep her temp down.

18.30 - "Her lungs are very wet we need to suction again, pulseox is crashing, 79%. Call respiratory! We need to get her on a vent" yelled Kate. They suctioned her lungs while her pulse was increasing rapidly and her body started shivering. "Breath sounds not great guys we need a portable x-ray up here stat! I can't wait for resp to get here, we should intubate I don't want to lose the airway." said Kate. Sonia was crying, Sara and Lindsey was next to her, holding her tight. They were standing next to the wall, out of the way. Pulse is up to 150" said Dr Altman. "Get me some adenosine she's going into supraventricular tachycardia" exclaimed Kate. "Come on Tegan, work with me" Kate mumbled under her breath. "Ok Karev, I'm going to need an echo please." Kate took an echocardiogram of Tegan's heart and had a very concerned expression on her face. "I'm not liking what I'm seeing at all guys" she said. The room was filling up now…. A large number of doctors were working on Tegan, trying to stabilize her but to no avail. Tegan's condition deteriorated by the minute. "Temps up to 106.2…" Tegan was completely covered in ice packs, cooling blankets and given a variety of drugs to bring her fever down, nothing was working. Her fever continued to spike.
"Dammit guys we need more ice packs, cool the room some more, we need to get this temp down NOW!" yelled Kate. One of the nurses screamed "She's not breathing, respiratory arrest" Karev calmly said: "No breath sounds on the left or right let's bag her, get an intubation kit ready"

Lindsey, Sara, Erin and Sonia were forced outside earlier and was pacing the hallway nervously. Sara saw a light above Tegan's door – it was red and it was on… what does that mean?

"OK let's intubate" said Kate. Tegan started shaking uncontrollably, every muscle in her tiny body violently contracting "She's seizing" screamed Kate. Let's get 1mg of menadil and dexadril in her. They turned Tegan onto her side as she continued to seize for about 30 seconds. An alarm sounded… Tegan's seizing stopped… so did her heart…..

Sara was staring at the red light above Tegan's door, suddenly it turned blue and was blinking on and off….. "Code blue, ICU 1, Code Blue, ICU 1" a voice said over the speaker system" That's Tegan's room…. Lindsey felt her legs give way under her, she was standing against the wall and she sunk to the floor slowly…

"She's coding - we've got VF on the monitor let's prepare to shock her at 200, I'm starting cardiac massage" exclaimed Kate. More people came rushing into Tegan's room, including Sara. She looked around in distress. The room was crazy. Kate was standing on a small step pumping vigorously on Tegan's chest. Somebody had a mask over her face and was pumping air into her lungs. Somebody removed Tegan's gown from under Kate's hands and placed 2 orange pads on her naked chest. One above her right breast and one below her left. "Epi's in" shouted a nurse "OK let's shock her at 200" said Kate as she took the defibrillator paddles from the nurse. "OK everyone off - Clear – Shocking" Sara watched in horror as Tegan's body contracted from the current moving over her heart" She looked up at the monitor that continued it's wining and squiggly line. "Still V-fib charge to 300 please" "Charged" "OK everyone clear – Shocking" This time Tegan's body contracted significantly more causing her back to lift slightly off the bed" ….. Come on Tee…. Please... don't do this... Sara thought. "No change on the monitor let's go again – 360 - stay clear – shocking" yelled Kate. Tegan's entire upper body lifted off the bed. "Dammit no conversion I need a back board and another one of epi please" said Kate loudly. The team rolled Tegan's body and lifted her onto the backboard that would improve the quality of chest compressions. "Continuing cardiac massage" said Kate. She was pumping profusely on Tegan's chest "Come on buddy, come back to me, come on" she said under her breath. Sara stood frozen in one spot, holding her breath… unable to move a muscle.

Kate felt and heard a small pop under her fingers "dammit broke a rib" she mumbled. She continued with deep chest compressions, sweating as she did so. "Do we have a pulse with compressions?" she asked looking up. One of the team members felt for a carotid pulse in the neck and one for a femoral pulse in the groin. "I've got a strong carotid" said the one "kinda weak femoral but it's there" said the other. "30 Seconds of compressions remaining before rhythm check" said the lady recording the code. "Can somebody check on those labs please" asked Kate while still pumping hard on Tegan's chest. Tegan's body was jerking from Kate's hard compressions. "We need to switch after this shock please and I'll intubate her" said Kate. "I can do it" said one of the interns. "I'll do it – I want her vocal cords untouched!" Said Kate quickly. "Ok rhythm check in 5, 4, 3, 2, 1" Kate stopped pumping and stared desperately at the monitor "No change – no pulse, still VF" let's shock her again at 360" Kate looked panicked as she grabbed the paddles and put them on her friend's chest once more "everyone clear - Shocking" Sara heard the machine make a thump noise again, everything felt like it was happening in slow motion. Kate stared at the monitor which for a second or two showed a flat line and then some life giving spikes. beep, beep, beep, beep – "Got her, she's back in sinus" exclaimed Kate relieved. Sara felt somebody putting their arm around her and lead her outside, she was on autopilot – in complete shock…

"Pressure's only 60 palp, let's up the dopamine" said Dr Altman. "Dr Morgan, there's still no breath sounds, she's in full respiratory arrest." said Karev listening to Tegan's lungs. Kate moved to the head of the bed where Karev was still bagging Tegan. Tegan's entire mouth had a blue tint around it. "Pulseox please" she asked. "PO at 69 only" said a nurse sounding concerned. Tegan's heart didn't like this and she was having a wave of PVCs.

"OK Teebag just stay with me" muttered Kate. Kate tilted Tegan's head back and opened her mouth. She put the sophisticated laryngoscope blade down Tegan's airway. "I need some cricoid pressure please" she said urgently. Karev placed two fingers on Tegan's throat and pressed down. "I need video please" Somebody switched on a video screen feeding from a small camera at the end of the laryngoscope blade… "Ok I see the chords" the tube was placed down Tegan's airway "and I'm in" Kate conveyed calmly before pressing the plunger connected to the balloon at the end of the tube "Ok bag her" she said calmly. The resp tech pressed the ambubag attached to the end of the tube rhythmically, forcing air into Tegan's sick lungs. "Ok breath sounds are equal bilaterally. Bag her with 100% O2 at about 12 bpm, let's get her on a vent asap" said Kate while holding the stethoscope over Tegan's chest. "Temp's 104.5" said Karev. "OK guys we're going to need more ice, let's send some cooled air down that vent and flush some cooled saline.

Tegan's entire body was still shivering violently from the fever. Tegan started seizing again "Not again!" Yelled Kate. "One of decodrone please" Tegan stopped seizing but her heart monitor alarm was sounding again. "She's in SVT again, let's get 6mg of adenosine - rapid IV bolus please." Tegan's body jerked and shivered a lot less after a round of seizure meds, her heart rhythm returned to normal slowly. "Temp's down to 102.5" said a nurse "Good, good let's keep doing what we're doing – Dr Altman I'm going outside for a minute to update the family can you run this please"

Kate stopped by the door just before exiting – she breathed deeply with her hands on her sides. And slowly exhaled through her mouth as if to calm herself. "You want me to do it?" asked Altman behind her, hand on her shoulder. "No I'm good, just taking a moment" said Kate slightly embarrassed.