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

Inside the room, the doctor at the bedside was still checking Shao Dequan's oxygen supply.

The nurse at the observation station crouched down to check the flow meter, then followed the tubing to the head of the bed: "The nasal cannula is running at four liters per minute, the oxygen level is normal, and the tubing isn't broken. I switched the finger clamp to my right hand, but it's still 91."

As she spoke, Shao Dequan closed his eyes again.

The doctor patted his shoulder beside the bed: "Shao Dequan, don't sleep. Where are you now?"

He only opened his eyes after being called twice: "Hospital."

Which hospital?

Shao Dequan's lips moved, and after several seconds he finally said "City First Hospital".

The nurse has already handed the arterial blood gas collection needle to the bedside.

Another nurse checked her fingertip blood glucose level, which was 6.7, and then re-attached the blood pressure cuff.

Blood pressure 102/64, body temperature 39.2 degrees Celsius.

In the few dozen seconds it took for him to speak and turn over, his blood oxygen level dropped another bar, and the monitor reported 90.

The doctor stood in front of Shao Dequan and asked him to raise both hands at the same time.

Shao Dequan understood, and his movements were slow, yet symmetrical on both sides.

When he shook hands again, there was no obvious difference in strength between his left and right hands.

The nurse brought a flashlight. The doctor at the bedside checked both pupils and asked him if he had suddenly experienced a headache or numbness in one hand or foot.

Shao Dequan shook his head and quickly closed his eyes again.

"Blood sugar is not low, and no obvious unilateral limb abnormalities have been observed yet." The bedside doctor instructed the nurse, "Wake her up every few minutes for a reassessment, and report immediately if her consciousness deteriorates further."

The bedside doctor asked the nurse to record the time of this physical examination and blood glucose measurement together, so that if the reaction continues to slow down, the results can be directly compared before and after.

After listening through the intercom, Lin Ye directly asked the nurse in the observation station, "What time was the last time he was able to speak a complete sentence?"

"Let me take a look."

The nurse turned to the previous page of the observation record.

When his temperature was taken at 5:38 PM, Shao Dequan asked when he could call his wife again. His sentences were complete and he was lucid.

Later, at 5:51 PM, when his pulse oxygen finger clip was being changed, the nurse called his name twice before he finally extended his hand. At that time, the nurse asked him if he felt tightness in his chest, and he replied, "I'm so sleepy."

Lin Ye then asked, "When was the oxygen flow rate adjusted to four liters?"

The nurse flipped to the next page.

At 5:44 PM, Shao Dequan's blood oxygen saturation dropped from 93 to 92 with oxygen administered via nasal cannula at a rate of 3 liters per minute. The bedside doctor had already adjusted the oxygen flow rate to 4 liters, and it returned to 93 shortly thereafter.

This record is sandwiched between two routine measurements.

The numbers had rebounded, but the oxygen flow rate had already been increased by one level.

"The oxygen flow rate was increased by one level, and the response started to slow down after seven minutes." The nurse checked the time again.

Lin Ye reminded her: "Add oxygen adjustment at 17:44 and reaction slowdown at 17:51 separately, don't cram them into one column."

"At 5:51 PM, I recorded the blood oxygen level, but I was slow to react and missed it." The nurse flipped back to the corresponding column.

"Fill in my name as the executor," the doctor beside the bed added.

The nurse responded and reached for the record board at the foot of the bed.

Lin Ye heard her call Shao Dequan's name again. The old man opened his eyes, gasped for breath a few times, and then responded after several seconds.

The pale blue lettering at the edge of my field of vision changed.

[Gap Update: The Time Window for Consciousness Shifts Has Been Filled]

Lin Ye's gaze lingered on that line of text for a moment before he turned and dialed the medical on-call number.

Before the call connected, he moved the two records, one showing increased oxygen flow and the other showing a slower reaction, to the same page.

On the monitoring trend chart, after the oxygen flow rate was increased, the blood oxygen level of 93 was maintained for only a few minutes, and then fluctuated between 91 and 92.

As soon as the call connected, Lin Ye reported the timing of this change and the shift in consciousness.

"Shao Dequan's response slowed down, and he was able to respond completely by 5:51 PM at the latest. By 5:38 PM, he was still able to answer questions completely. Currently, his blood oxygen saturation is 90-91 liters per minute through the nasal cannula, and he is breathing 31 times per minute. Blood gas analysis has been performed, and the respiratory department is on their way."

The on-call medical officer inquired about the patient's blood pressure, blood sugar, and most recent stable blood oxygen level before contacting the medical treatment team.

Before the call ended, Lin Ye added, "His blood oxygen briefly returned to 93, but his reactions are still slow, and the change in consciousness cannot be treated as drowsiness."

"I heard that." Someone on the medical duty roster was reporting the vehicle's location. "Wait for the respiratory department's bedside assessment. His priority will be moved up, but the final transfer conditions will be determined by the treatment team."

Lin Ye put down the stethoscope and added "the response was still slow after a brief rise in blood oxygen" to the electronic record, followed by the bedside doctor's review time.

Before the respiratory specialists arrived, he checked Shao Dequan's medication records for that day again.

There were no sedative or hypnotic drugs listed in the medical orders and execution records since the afternoon, and the medications brought by the family have been kept sealed in the bag.

Lin Ye added the medication verification results and the sealed bag number to the bedside for handover.

Dr. Tang Wenjie, the on-call doctor in the respiratory department, arrived five minutes later.

He put on his protective gear in the buffer zone and entered the observation area along the designated route. Before he even reached the bed, the blood gas analyzer beside it had already output the results.

The nurse tore off the note and reported to Tang Wenjie: "Oxygen 4 liters, pH 7.47, oxygen partial pressure 53, carbon dioxide partial pressure 30, lactate 2.5."

Tang Wenjie placed the results on the bedside table and leaned over to ask Shao Dequan if his chest tightness and shortness of breath had worsened.

Shao Dequan managed to say, "I can't breathe," before being interrupted by a fit of coughing.

When the coughing stopped, the blood oxygen level was only 90%.

Tang Wenjie asked him to raise his hands again, and then asked if he had experienced any dizziness, lightheadedness, or chest pain. Shao Dequan understood, but each time he would wait a while before shaking his head.

The bedside doctor gave him the timeline of the changes in consciousness that had just been determined, and also explained the blood sugar, blood pressure, and preliminary neurological examination results.

Tang Wenjie retrieved the previous bedside reassessment record on the computer. Around 3 PM, when Shao Dequan was receiving oxygen via nasal cannula at a rate of 3 liters per minute, his blood oxygen saturation remained between 93 and 94, and his respiratory rate was 26 breaths per minute.

Now that the oxygen flow rate has been increased to four liters, my breathing rate has increased to thirty-one breaths per minute, and the oxygen partial pressure in my blood has also dropped.

"We just checked 93 again, and overall it's still trending downwards." Tang Wenjie turned the computer towards the doctor beside the bed.

After checking the breath sounds, Tang Wenjie asked the nurse to prepare a high-flow humidified oxygen therapy machine and called the medical treatment team back.

"The oxygen partial pressure under the 4-liter nasal cannula is 53, the response is getting slower and slower, and the respiratory rate is 31 breaths per minute. Switch to high-flow humidified oxygen therapy first; if the consciousness continues to deteriorate, the airway needs to be assessed in advance. The transport vehicle must be able to provide a continuous high-flow oxygen supply. Please coordinate the availability of beds in the infectious disease intensive care unit."

The medical treatment team took over the allocation of beds and vehicles.

The nurse brought in a high-flow humidified oxygen therapy machine, and Tang Wenjie set the initial parameters according to the bedside conditions. After the nasal cannula was replaced, the flow rate was adjusted to 45 liters per minute, with an oxygen concentration of 60%.

The warm, humid air rushed into his nasal cavity, and Shao Dequan instinctively reached out to touch the tube.

The nurse stopped his hand: "It's windy here, and you'll feel uncomfortable at first. Don't pull it down. If it's really uncomfortable, just nod, and I'll adjust it for you."

Shao Dequan moved his head and slowly put his hand back on the quilt.

The nurse adjusted his nasal cannula frenulum and moistened his dry lips with a damp gauze. Shao Dequan wanted water, but Tang Wenjie told him to moisten his mouth first, and the bedside doctor would assess whether he could drink after his consciousness stabilized.

Two minutes later, the blood oxygen level slowly returned to 93%.

Over the next few minutes, the nurse reported the blood oxygen and respiratory rate every two minutes. The blood oxygen level was 92 or 93, and the respiratory rate dropped from 31 to 29, then stopped at around 29.

Tang Wenjie first instructed him to open his eyes and raise his hands according to the given commands, and then asked for his name and age. Shao Dequan answered correctly, with a few seconds between each answer.

"The blood oxygen has risen a little, but the person hasn't caught up yet." Tang Wenjie instructed the doctor beside the bed, "Continue to monitor consciousness, breathing, and blood pressure, and check the blood gas again before transferring."

The work phone in the cleaning area rang at that moment.

The on-call medical officer told Lin Ye that the designated hospital's infectious disease intensive care unit had confirmed it would accept Shao Dequan. The negative pressure ambulance equipped with a high-flow-rate ambulance would arrive in another 25 minutes.

Lin Ye retrieved the next transfer handover form.

The previously empty train number column has now been filled with Shao Dequan's name.