When I'm on the night shift, all the department heads can't sleep.

Six minutes.

Lin Ye stared at the system countdown, his phone already dialing the anesthesiology department.

"Emergency room, suspected confined space gas poisoning, patient is confused, another patient who was left behind collapsed during transport. Anesthesiology department prepares airway."

The person on the other end of the phone only asked one question.

"How many minutes will it take?"

Lin Ye watched as the sound of police sirens grew closer and closer outside the door.

"Less than six minutes."

The on-call anesthesiologist said, "Right away."

Zhou Wei was still restless on the emergency bed.

He was wearing a high-flow oxygen mask, his eyes fixed on the ceiling, repeatedly muttering a name.

"Old Ma... Old Ma..."

Nurse Zhao pressed his wrist; sweat was already beading on his forehead.

"You should take care of yourself first."

Zhou Wei wouldn't listen.

The heart rate on the monitor spiked to 150.

Oxygen saturation is 99%.

This number is shining brightly.

She was so beautiful that anyone would have breathed a sigh of relief if it weren't for that bloody medical bill.

Qin Hai placed the blood-and-energy tablet beside the bed.

"Don't look at oxygen saturation. Look at the person."

Sun Zhiqiang is drawing blood from two other workers.

One of them was clutching his chest, saying he was fine.

"I'm just feeling a bit bored, I'll be fine after a rest."

Sun Zhiqiang looked up.

"Zhou Wei also said it would be done in a little while."

The man shut up.

The ambulance came to a stop at the emergency room entrance.

As soon as the car door opened, two paramedics rushed in pushing a stretcher.

The man on the flatbed cart was in his fifties, his gray work clothes were open, his chest was barely rising and falling, and his face was ashen.

A little white foam hung from the corner of his mouth.

The oxygen mask was on my face, and the fog inside was very light.

The paramedics pushed the vehicle while shouting.

"Ma Jianguo, 56 years old. He suddenly collapsed in the guardhouse and became unresponsive. He was given oxygen on the way, with a blood pressure of 96.6, a heart rate of 130, and a pulse oximetry of 100."

Qin Hai did not check the oxygen saturation level.

"consciousness?"

"It reacts to painful stimuli but cannot answer."

"Are you having any convulsions?"

"No obvious convulsions, but vomited once on the way."

Nurse Zhao had already pulled out another emergency bed.

"Go to bed."

When Ma Jianguo was moved to the emergency bed, his head was turned to one side, and he gagged again.

Lin Ye immediately handed over the attractant.

"Clean the mouth first to prevent aspiration."

Qin Hai stood at the head of the bed.

"High airway risk. Has the anesthesia taken effect?"

Footsteps could be heard outside the corridor.

The on-duty anesthesiologist carried in a tracheal intubation kit.

"Who needs an airway prepared?"

Qin Hai refers to Ma Jianguo.

"Exposure to an unknown gas in a confined space, altered consciousness, vomiting, and risk of aspiration. Assess the airway first."

The anesthesiologist looked down to examine the mouth and breathing.

"The tongue is not significantly retracted, but the protective reflexes are poor. First, place the patient in the lateral decubitus position, perform suction, and administer oxygen via face mask, preparing for intubation. If the patient's consciousness deteriorates further or oxygenation and ventilation become unstable, intubate immediately."

Qin Hai nodded.

"Do it this way."

Lin Ye pushed the arterial blood gas application form over.

"Carboxyhemoglobin, lactate, electrolytes, cardiac markers—the same set as Zhou Wei's."

Nurse Zhao glanced at him.

"You're quite adept at offering set meals now."

Lin Ye didn't take the joke seriously.

"This cannot be missed."

Ma Jianguo's coworkers stood outside the door, their faces pale.

"Doctor, he just said he was fine and was sitting in the guardhouse drinking water."

Liu Zhenhua stopped him.

"Have you been inside the pump room?"

The coworker shook his head, then nodded.

"I just went to the door and took a look."

Liu Zhenhua handed him the notebook.

"The entrance counts too. Write down the name, phone number, how long they were inside, where they were standing, and who collapsed inside."

The worker's hands were shaking.

"Our factory manager told us not to talk nonsense."

Liu Zhenhua's face darkened.

"If you don't speak up now, and one person inside is missing, who will be held responsible if someone dies later?"

The coworker's lips trembled as he finally took the pen.

In the emergency room, Ma Jianguo's blood and energy levels returned quickly.

Higher levels of lactic acid.

Metabolic acidosis is more severe.

Carboxyhemoglobin levels were significantly elevated.

Qin Hai's expression grew even colder after reading it.

"The hyperbaric oxygen therapy department will do it again."

Lin Ye dialed the phone and directly reported the numerical values ​​and the state of consciousness.

There was a two-second silence on the other end of the hyperbaric oxygen therapy team.

"Ma Jianguo is unconscious, with high carboxyhemoglobin and high lactate levels, meeting the criteria for emergency assessment. Administer high-flow oxygen to ensure airway safety. If vital signs permit, transfer him to a hyperbaric oxygen chamber as soon as possible; if the airway is unstable, intubate to stabilize him before transferring."

Qin Hai listened on speakerphone.

"Emergency intensive care beds are ready, and anesthesia is available."

"We're preparing to open the hatch here."

The phone hangs up.

Zhou Wei suddenly fell silent.

It's strangely quiet.

Nurse Zhao lowered her head.

"Zhou Wei?"

Zhou Wei's eyes were unfocused, and he stopped struggling with his hands.

The heart rate monitor showed a drop from 150 to below 150.

One hundred and thirty-eight.

One hundred and twenty-six.

Blood pressure also dropped.

Sun Zhiqiang's expression changed.

"Director Qin, Zhou Wei is wrong."

Qin Hai immediately turned around.

"Look at his pupils, call out to him, apply pain stimulation."

Lin Ye pressed down on Zhou Wei's shoulder.

"Zhou Wei, can you hear me?"

Zhou Wei did not answer.

Nurse Zhao uses a flashlight to check the pupils.

"The pupils are the same size and still react to light."

The anesthesiologist has moved to Zhou Wei's bedside.

"Decreased consciousness, weakened protective reflexes. Intubation should be prepared for this as well."

Two emergency beds.

Two impairments of consciousness.

The same factory area.

The same gas, of unknown origin.

The factory manager stood outside the gate, his safety helmet deformed from his grip.

He whispered, "How could this happen... We made sure the room was ventilated..."

Qin Hai heard it.

"Good ventilation doesn't mean there's no toxicity. A person collapsing doesn't mean they've recovered. High oxygen levels don't mean it's safe."

The person in charge was speechless.

The anesthesiologist and Qin Hai exchanged a glance.

"Zhou Wei, please insert first."

Qin Hai nodded.

"Record indications: decreased consciousness, poor airway protection, suspected inhalation poisoning, prevention of aspiration, prepare for transport."

Nurse Zhao immediately repeated it.

"Decreased consciousness, poor airway protection, suspected inhalation poisoning, prevent aspiration, prepare for transfer."

Lin Ye watched as she wrote down the time.

10:56.

Zhou Wei is preparing for endotracheal intubation.

Ma Jianguo was given continuous high-flow oxygen and was prepared for intubation.

Prepare emergency intensive care beds.

Preparations are underway to open the hyperbaric oxygen chamber.

Each line looks like it's racing against a countdown.

The intubation process was quick.

After the anesthesiologist secured the catheter, Nurse Zhao connected the breathing bag, and the chest's rise and fall finally stabilized.

Qin Hai listened to the breath sounds on both sides.

"Both sides. Fixed."

Zhou Wei's heart rate stopped dropping.

One hundred and twenty-two.

Blood pressure: 98-62.

Not pretty.

But we managed to stabilize the situation first.

Ma Jianguo vomited again.

The anesthesiologist glanced at it.

"Let's not wait for this one either."

Qin Hai did not hesitate.

"Insert."

The factory manager's legs went weak and he almost sat down on the ground.

Liu Zhenhua asked the security guards to help him up.

"You can't fall now. The on-site list hasn't been finalized yet."

The person in charge was covered in sweat.

"Another security guard went in to check... He said it was fine and went back to his dorm."

Liu Zhenhua's expression changed instantly.

"Telephone."

The person in charge immediately dialed.

No one answered.

Liu Zhenhua told the security guard directly, "Notify 120 and the factory area. Don't wait for him to answer the phone; go to the dormitory to find him."

This time, even Nurse Zhao didn't complain.

The only sounds in the emergency room were the breathing bags and monitors.

After Ma Jianguo was intubated, his oxygenation and heart rate gradually stabilized.

The hyperbaric oxygen therapy department called again.

"The ward is ready. Can the two intubated patients be transferred?"

Qin Hai looked at the anesthesiologist.

The anesthesiologist said, "With your airway stable, take the breathing bag and monitor with you. I'll accompany you on the way."

The emergency room intensive care doctor has also arrived.

"Should we transfer them to the emergency intensive care unit first, or go directly to hyperbaric oxygen therapy?"

Qin Hai put the two blood gas reports, intubation record, and monitoring trend together.

"Both patients have impaired consciousness and high carboxyhemoglobin levels. The hyperbaric oxygen therapy unit is ready, and anesthesia will ensure airway management. They will be transferred to hyperbaric oxygen therapy first, and then transferred to the emergency intensive care unit for further monitoring. Other patients exposed at the same time should remain under observation and are not allowed to leave."

The hyperbaric oxygen therapy doctor added on the phone.

"Recheck contraindications and vital signs before entering the ward. Bring all necessary resuscitation equipment to intubated patients."

Qin Hai agreed.

"Follow the procedure."

Lin Ye clipped the transfer slip onto the board.

Zhou Wei.

Ma Jianguo.

The two names were written side by side on the paper.

The same few words followed.

Suspected inhalation poisoning.

Impaired consciousness.

High-flow oxygen.

Endotracheal intubation.

The patient is scheduled to undergo hyperbaric oxygen therapy.

As he wrote this, a system notification flashed.

[On the sixth night, additional high-risk patients were added to the effective treatment process.]

[In-hospital deaths: 0.]

[Zero-fatal ER weekly progress: 6/7]

It's not seven.

It's still six.

Lin Ye looked at the line of numbers and breathed a sigh of relief.

The emergency room didn't finish its nighttime schedule ahead of schedule just because it treated an extra batch of patients.

In the corridor, two flatbed carts were pushed one after the other toward the hyperbaric oxygen chamber.

The factory manager followed behind, still clutching the unfinished list in his hand.

Nurse Zhao walked past him, coldly tossing out a remark.

"Don't say they've all been delivered before you've counted all the people."

The person in charge lowered his head.

"understood."

Liu Zhenhua stood in front of the nurses' station, completing the new list.

What we saw: Many people experienced dizziness, nausea, and fainting after working in confined spaces; even those who went in to rescue people felt unwell.

Don't do these things: Don't put them directly into the emergency room lobby, don't just check their pulse oximetry, and don't let anyone else go home.

Who to call: Emergency second-line staff, on-call staff, security and infection control, 120 command center, hyperbaric oxygen therapy department, and emergency response departments if necessary.

After he finished writing, he did not put down his pen immediately.

"Qin Hai".

Qin Hai was washing his hands and didn't even look up.

"explain."

Liu Zhenhua looked at the increasingly thick list on the wall.

"The hospital director will definitely ask tomorrow, 'Two more items were added on the second night of the trial run of the checklist. Is the emergency department about to drag the whole hospital down with them?'"

Qin Hai shook the water off his hands.

"Just tell him."

He looked up and glanced in the direction of the hyperbaric oxygen channel.

"No delay tonight, the entire hospital will hold a memorial service tomorrow."

Liu Zhenhua paused for two seconds, then wrote the sentence down in his notebook.

Nurse Zhao noticed this and her eye twitched.

"Director Liu, should we write this down too?"

"remember."

Liu Zhenhua closed the notebook.

"The exact words may not be allowed at the meeting, but the meaning must be conveyed."

The system interface quieted down.

The silence at the entrance to the emergency room didn't last long.

At 1:27 a.m., the 120 emergency hotline called again.

Nurse Zhao answered the phone, and her expression gradually changed.

"Director Qin."

She covered the receiver.

"On a bus at a highway service area, more than a dozen people were vomiting and had diarrhea. Two of them were elderly and had dehydration and low blood pressure. There were also children on the bus."

Qin Hai closed his eyes.

"Another wave?"

Lin Ye looked at the system interface.

The gray cursor flashed once.

[The final night of Zero Fatal ER Week.]

[Keywords: diarrhea, dehydration, elderly, children.]

Outside the emergency room, the night wind rustled the still-dry list in the corner.

This wave has finally arrived.