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

Qin Hai put the phone back on the landline and picked up Xu Wenliang's transfer records and three video reports.

"Come with me to the fever clinic handover area. Nurse Zhu, keep an eye on the triage and internal line. If there are any changes in the emergency room, call the on-duty doctor in the second consultation room first, then call me."

Nurse Zhu was still checking the cleaning records at the outer triage point when she heard this and looked up: "I'll handle things here. You all go through the designated passage. When you come back, dispose of your protective equipment according to the requirements of the fever clinic. Don't touch anything at the nurses' station."

Lin Ye took the three people's examination numbers, onset times, and current whereabouts with him, and followed Qin Hai from the side entrance of the emergency room to the fever clinic.

After the two men put on their protective gear as required in the clean zone, they crossed the buffer zone into the handover area, where the ambulance's rear door was already open.

Xu Wenliang was still wearing an oxygen mask and was secured to the transport bed.

The paramedics hung the portable oxygen cylinder on the side of the bed, pushed the person through the access control, and the fever clinic nurse took over the head of the bed and first connected the portable oxygen tubing to the oxygen supply interface on the wall.

Lin Ye took the vehicle recorder and his gaze fell on the column "Blood oxygen 92 percent after oxygen administration".

A light blue notification flashed by next to the blank space on the vehicle's dashcam.

[Risk Direction: Increased risk of hypoxia progression]

Key gaps: oxygen delivery method and flow rate, changes before and after transport, and blood gases after oxygen therapy.

He looked down along that column.

The measurement time has been specified, but the oxygen delivery method and flow rate are left blank.

"Under what oxygen supply conditions was the 92 measured?"

The paramedic glanced back at the portable oxygen cylinder: "Mask oxygen, six liters per minute. When we first picked him up upstairs, he was maintaining a rate of 92. As we carried him down from the sixth floor, it dropped to 90 at one point, but it returned to around 92 after he was put in the ambulance."

Luo Wenbin, the doctor on duty at the fever clinic, was standing by the observation bed when he heard this. He immediately looked at the nurse and said, "Connect the IV line to 6 liters first, make sure the tubing isn't broken. Replace the finger on the pulse oximeter clip, and secure the cuff properly. Take another reading after you move it to the bed."

Xu Wenliang was moved to an observation bed, and the nurse raised the headboard so he could sit or lean against it. After the oxygen supply was connected, his blood oxygen levels continued to fluctuate between 91% and 92%.

Luo Wenbin raised his voice slightly through his mask: "Where do you feel the most pain right now?"

Xu Wenliang had just uttered "a tightness in my chest" when a cough stopped him from saying anything more.

The heart rate on the monitor remained between 117 and 120, the blood pressure was 104/66, and the body temperature was 39.3 degrees Celsius.

Luo Wenbin counted the rise and fall of the patient's chest; it had already exceeded sixteen times in half a minute.

"His breathing is still around thirty breaths per minute. Don't lay the bed flat yet. Take your time when asking about his medical history, and don't let him talk for too long at a time."

After listening to the breath sounds on both sides, Luo Wenbin instructed the nurse to first draw blood gas from the bedside and establish intravenous access at the same time, and to complete blood routine tests, inflammatory markers, liver and kidney function tests, and coagulation function tests.

The blood gas sample had just been sent away, and the blood oxygen level on the monitor was still around 91%. The nurse then changed him to a mask with an oxygen reservoir as requested and adjusted the oxygen flow rate to 10 liters per minute.

A few minutes later, the number returned to between ninety-three and ninety-four, and the breathing remained rapid.

After Luo Wenbin's blood oxygen levels stabilized for a while, the nurses were allowed to prepare respiratory specimens.

The nurse first checked the name, sampling time, and observation bed number on the sampling tube. The oxygen line was kept on during the sampling. She quickly completed the nasopharyngeal swab collection, then reset the oxygen reservoir mask and continued to monitor blood oxygen levels.

Specimens required for rapid screening and subsequent pathogen detection are also collected separately.

After being agitated, Xu Wenliang coughed for a while, and his blood oxygen level briefly dropped to 92.

The nurse stayed by the bedside and watched until the number returned to above 93 before sending the sample tube out.

The oxygen mask was fastened tightly, and after taking a few breaths, Xu Wenliang reached out to touch it.

The nurse stopped his hand and spoke slowly, "You can't take this off now. If you feel stuffy, just nod. I'll watch over you by the bed. You'll be even more breathless if the oxygen stops."

Xu Wenliang nodded reluctantly, his hand falling back to the edge of the bed, his chest heaving without slowing down.

The bedside blood gas results were quickly transmitted to the workstation.

After reviewing the results, Luo Wenbin read several key findings to Qin Hai: "Under six liters of oxygen in the mask, the partial pressure of oxygen is 58. The partial pressure of carbon dioxide is 31, and the lactic acid is 2.2."

After hearing the results, Qin Hai asked, "Where is the infectious disease department?"

"They've already come down from the ward, and the infection control team is on their way."

A few minutes later, Xu Mingzhe from the Department of Infectious Diseases arrived at the clean area of ​​the fever clinic.

The nurse reported the current oxygen flow rate into the internal line. He looked at the respiratory rate on the monitor screen and then pulled up the image report that Han Zheng had just signed.

Xu Mingzhe pressed the intercom leading to the observation area: "The oxygen mask is already set to 10 liters, but the blood oxygen level is only 94. This number needs to be recorded along with the oxygen flow rate. Continue single-room monitoring, and repeat the blood gas analysis according to the patient's condition. Report to the second-line respiratory department first. If the oxygenation level drops or the work of breathing continues to increase, have them immediately connect the patient for assessment."

Luo Wenbin added the oxygen therapy information to the electronic medical record, and then retrieved the sampling records of the other two people: "The samples of Gao Limin and Shao Dequan have been sent for testing, and Gao Yuan's is in the same batch. Xu Wenliang's sample was just sent. The common respiratory disease test was done before, and the additional tests will be assessed by the infectious disease department. The hospital infection control department will register them simultaneously."

Xu Mingzhe checked the sampling times of the four people and then turned to the epidemiological registration forms of three patients with abnormal imaging results.

Gao Limin's form had "at home" filled in the activity section before the onset of the illness, Shao Dequan's form was still blank, and Xu Wenliang's form stopped at the time when the symptoms started because of his shortness of breath.

When the infection control staff arrived, they first placed the three forms separately in the records of different patients: "Continue to check the people who stayed in the CT waiting area. These three people had symptoms before entering the hospital. We need to ask them separately where they went and who they came into contact with in the two weeks before the onset of the disease. Family members should also be registered separately, instead of sitting together and trying to recall."

The list of those who have already left the hospital will continue to be maintained by the Infection Control Department, while the whereabouts of Gao Limin and Shao Dequan will be investigated by their respective clinics.

Xu Wenliang will focus on oxygenation first, and once he can speak more easily, he will then proceed with the history of his nuclear disease.

Lin Ye opened Xu Wenliang's vehicle log and reported the changes in oxygen therapy that had just been updated into the intercom: "When using a 6-liter mask, the level remained low, and it only returned to around 94 after switching to a reservoir mask."

On the other end of the line, Xu Mingzhe checked the time: "This part will be left in the handover. When the shift changes, oxygen flow and blood oxygen will be reported together."

When Luo Wenbin refreshed the test page, the first batch of blood routine and inflammatory indicators had already come out.

Xu Wenliang's total white blood cell count did not increase significantly, his absolute lymphocyte count dropped to 0.6, his C-reactive protein was over 70, and his procalcitonin level did not increase significantly.

Xu Mingzhe forwarded the report to Luo Wenbin, asking him to send it along with the blood gas and oxygen therapy conditions to the second-line respiratory department.

Xu Mingzhe added over the intercom: "Put these into the disease progression tracking for now; we'll have to wait for specimens to determine the pathogen. Increase oxygen levels further, or report again immediately if the patient starts to lose their voice."

In the registration area on the outside, Xu Jing handed her father's ID card, the receipt for the medical record, and his usual medications to the nurse.

She sat in the front cabin of the ambulance as instructed by the emergency personnel and went to the hospital. After entering the hospital, she stayed directly in the registration area outside the fever clinic and did not go through the regular outpatient clinic.

She couldn't see what was happening inside through the glass, and her phone had already rung three times.

After checking the medication name, the nurse handed the phone back to her: "Was that a call from home?"

"My mom." Xu Jing glanced at the incoming call and then turned the volume down. "She's home alone. When she heard that my dad was in the observation area, she insisted on coming over to bring him clothes. I couldn't stop her. She also said that my dad left his phone in the taxi and couldn't even pay the hospital bills."

Xu Mingzhe came out of the work area and spoke to her through the glass door of the registration area: "Have your mother stay at home first, don't take a car to the hospital. You can leave the payment and phone later. Your father's emergency treatment won't stop just because he doesn't have his phone. Give the nurse your mother's name, ID number, and contact number. Keep her phone accessible tonight, as infection control or local staff will call to verify the situation."

After listening, Xu Jing turned around and called her mother back, telling her to lock the door, not to pack her clothes, and not to rush to the hospital.

The person on the other end of the phone was still pressing for answers, so she walked to the other side of the registration area and patiently repeated what the doctor had just said.

After completing the handover, Qin Hai and Lin Ye entered the buffer zone according to the designated route, removed their protective equipment in turn, and returned to the clean zone after washing their hands.

A message from Ma Hao appeared on the phone screen stored in the cleaning area.

Should I go as scheduled tomorrow morning? No one's been saying anything in the ER group chat; the more I see, the more uneasy I feel.

Lin Ye glanced at the time; it was almost eleven o'clock. He called him back.

Don't come early; prepare according to the original schedule. We'll notify you of any departmental adjustments, so please keep your phone on.

Ma Hao quickly replied with "Okay," followed by another message.

Are you unable to leave tonight?

Just as Lin Ye was about to reply, the internal phone at the fever clinic counter rang first.

After the nurse answered the call, she first checked Gao Yuan's sample number; the sample was still being tested.

The laboratory then reported the rapid results for three patients with abnormal imaging findings: "Gao Limin, rapid tests for influenza A, influenza B, and respiratory syncytial virus were all negative. Shao Dequan, and Xu Wenliang were also negative in all three tests."

Other respiratory pathogens are still being tested.

Xu Mingzhe compared the three imaging reports and the quick results, picked up the intercom, and recited the names, examination numbers, and sampling times of the three people.

"These three respiratory specimens will be retained for registration. Other tests will proceed as usual. The remaining specimens will be kept separately."

The lab confirmed: "Keep all three samples?"

"Keep them all. When a review is needed later, none of them can be omitted."