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

"The IV fluids are sodium chloride, 500 ml, started at 11:40 and stopped at 12:55. Furosemide 20 mg was administered at 1:30 PM. The ward is still checking how much has been administered so far."

The monitor's alarm continued to sound.

"The blood oxygen level is still at 87." Nurse Zhu stared at the screen. "The non-invasive pressure has increased, and the patient is starting to become uncooperative."

A wisp of white mist leaked from the edge of the mask. Liu Guoqiang reached out to grab it, but his fingers paused twice in mid-air before finally touching the pipe.

"Director Zhou, we've got the infusion time, but the dosage hasn't been verified yet." Lin Ye covered his phone, his eyes never leaving the monitoring screen. "His blood oxygen is still dropping."

Zhou Min returned to the bedside, glanced at Liu Guoqiang, and then looked at Nurse Zhu.

"Prepare for potential airway decompensation. Are all the intubation equipment in the resuscitation vehicle ready?"

"The ambulance has arrived at the bedside, and the items are being checked."

Zhou Min nodded: "What about the anesthesiology department?"

"Still on the way."

"Keep urging him. When Director Qin arrives, let him see the family first. Lin Ye, you keep an eye on the patient. Report immediately if any blood gas is detected."

The person on the other end of the phone was still explaining something.

Lin Ye held the phone close to his ear.

"The patient's non-invasive oxygen saturation is currently 87%, and breathing is becoming increasingly difficult. We are treating this as airway decompensation. We will verify the results and report them directly to the receiving physician."

The other party agreed, and the call was temporarily disconnected.

Zhou Min looked down and noted the time: "2:39 PM, three minutes after the non-invasive procedure began."

Lin Ye looked down at Liu Guoqiang.

His breathing became increasingly rapid, his chest and abdomen rising and falling almost without pause, and only intermittent breaths could be heard from under his mask.

"The blood and qi results are in."

Nurse Zhu handed over the report.

Lin Ye glanced at the report and handed it to Qin Hai, who had just arrived at the door.

The anesthesiologist followed him into the emergency room.

"Poor oxygenation, elevated carbon dioxide levels, and blood oxygen levels are still dropping even with non-invasive treatment, and the reaction is slowing down."

The anesthesiologist took the report and bent down to call Liu Guoqiang.

"Grandpa, can you open your eyes? If you can hear me, please shake my hand."

Liu Guoqiang did not respond.

The doctor glanced at the non-invasive mask and then checked Liu Guoqiang's breathing and blood pressure.

"Non-invasive oxygenation cannot be maintained, and the patient's consciousness and responsiveness are deteriorating. Prepare for endotracheal intubation."

Nurse Zhu pushed the suction device, balloon, and monitoring equipment to the bedside.

The anesthesiologist instructed Liu Guoqiang to continue receiving high-concentration oxygen to complete pre-oxygenation, and confirmed the monitoring, intravenous access, and intubation equipment, without inducing induction for the time being.

The doctor looked at Lin Ye: "When did it start to get worse?"

"Liu Guoqiang, before being transferred from the Second Hospital, his blood oxygen level was reported as 94, or 3 liters of oxygen. After arriving at the hospital, it was 91. He was then given a 10-liter oxygen mask, and his highest level reached 93, before dropping to 88. Non-invasive ventilation started at 2:36 PM, with a highest level of 92, and is currently at 87."

"What about an IV drip?"

"The dosage is still being checked. The Second Hospital administered 20 mg of furosemide at 1:30 PM."

The anesthesiologist nodded and turned to instruct Nurse Zhu to prepare the airway equipment.

Qin Hai looked at Lin Ye: "Have the family members arrived?"

"My daughter and son-in-law are outside the door; they are the only family members we can contact at the moment. The patient may need intubation, but we haven't completed the detailed informed consent process yet."

"The anesthesiology department has completed the bedside assessment. Next, I will explain the risks of intubation to the family."

Qin Hai turned and walked out of the emergency room.

Through the glass, Lin Ye heard his daughter's voice: "Do we need to intubate?"

Her son-in-law supported her arm.

"Now, non-invasive procedures are not stabilizing blood oxygen levels, and patients are finding it increasingly difficult to breathe."

Qin Hai stood in front of her.

"The anesthesiology department has assessed that immediate intubation and mechanical ventilation are necessary. This process carries risks, and intubation does not guarantee immediate improvement."

The daughter held the helmet to her chest.

"If he's on a tube, will he be unable to breathe on his own?"

"We'll need machine assistance for a short period. Whether we can remove it later depends on the condition of the lungs and recovery. The anesthesiology department will also provide additional information on the risks of induction, intubation, and airway complications."

The son-in-law took the phone from the caregiver and put it in his pocket.

"The Second Hospital called several times, but Dad didn't answer."

She turned to look at the emergency room, her face reflected in the glass door, her eyes already red.

"He went grocery shopping this morning."

Qin Hai handed her the informed consent form.

"Now you need to decide whether you agree to endotracheal intubation and subsequent respiratory support."

"During induction and intubation, there may be a drop in blood pressure, aspiration, or difficulties in establishing the airway. We will continue to monitor and deal with any issues immediately."

The son-in-law spread the consent form on a small table by the wall, and the woman took the pen but hesitated to sign it.

"Doctor," she looked up, "if I had known sooner, things wouldn't have come to this."

"Let's finish the immediate rescue efforts first. We'll continue to verify the missing data."

The woman bowed her head and signed: "I agree."

The anesthesiologist returned to the bedside, confirmed the signature, and began induction.

Nurse Zhu kept an eye on the blood pressure and blood oxygen levels, while Lin Ye stood by the bedside and called out the numbers.

Lin Ye then stepped back to the foot of the bed and handed over the medication information that the Second Hospital had provided via telephone.

The Second Hospital initially estimated that about 350 milliliters had been injected, but the official record is still pending confirmation.

"Ceftriaxone 1 gram at 1 PM. Furosemide 20 mg at 1:30 PM. Penicillin allergy, the reaction was a full-body rash, no history of shock."

"The infusion volume has not yet been verified. The start and stop times are based on the records of the Second Hospital."

The intubation process did not last long.

Lin Ye stood by the bed, delivering items and reporting monitoring numbers as instructed by the anesthesiologist.

After the tubes are inserted, the anesthesiologist uses end-tidal carbon dioxide and auscultation of both lungs to confirm the location before connecting the ventilator.

After a brief drop, blood oxygen levels slowly returned to 94.

The anesthesiologist stepped back half a step, making room for the head of the bed.

"The piping is fixed."

Nurse Zhu looked down to confirm the fixed position, and Lin Ye glanced at the monitoring screen and noted down the time.

"At 3:03 PM, the blood oxygen level was 94 after connecting the ventilator."

Qin Hai made a final check at the bedside.

"Prepare for transfer to intensive care unit, contact for available beds."

Zhou Min came in from outside, still holding the phone.

"The initial reading from the Second Hospital ward is approximately 350 ml, but the official record has not yet been confirmed. The imaging data is still being transferred."

Lin Ye nodded and added the number to the record.

My daughter was beside me as the transfer bed was wheeled out of the emergency room.

She didn't ask "when will it get better?" again, but just looked at her father through the bed railing, her hand resting on the railing.

"Where should he be taken?"

Lin Ye glanced at the transfer bed.

"Intensive care. They will continue to monitor the patient on a ventilator, and the situation will depend on the recovery of the lungs."

The woman nodded and withdrew her hand.

The door to the intensive care unit opened, and a transport bed was pushed inside.

The emergency room quieted down, and the alarm from the monitors was muffled behind the door.

Lin Ye returned to the examination table, where Zhou Min had already spread out the receipt, with the 350 ml initially verified by the Second Hospital written in the "Pending Confirmation" column.

"The video hasn't arrived yet."

"Remember to write the missing referral records and the patient's treatment separately."

Zhou Min glanced at him and handed him the pen.

Lin Ye first wrote down the time of admission, changes in oxygen therapy, the start of non-invasive procedures, and the time of intubation, and then listed the medications that had been verified one by one.

When he wrote "his breathing became more labored after the IV drip," he paused, crossed out that line, and rewrote it:

"According to the family's recollection, the patient's shortness of breath worsened before being transferred to another hospital, and the correlation with volume overload needs further verification."

After looking down at the receipt, Zhou Min filled in the time on the receipt form.

"This way, the successor can understand it."

Qin Hai returned from the intensive care unit and glanced at the records at the door.

"Complete the case history, and during the handover, mention the imaging and input volumes separately; hand over the rest as completed procedures."

Lin Ye closed the medical record. The emergency bed was empty. Nurse Zhu pushed the emergency cart past and put the used items back in their original places.

Zhou Min picked up the receipt and turned to answer the next call.

Lin Ye glanced at the record on the screen and followed.