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

The blood oxygen level on the monitor kept dropping.

91%, 86%, 81%...

The pointer on the peak airway pressure gauge was stuck at 42 cmH2O, and the piercing alarm whistle of the ventilator echoed in the quiet room of the intensive care unit.

The inner wall of the transparent corrugated tube was covered with large patches of dark pink foam, which surged upwards with the airflow and blocked the exhalation valve, producing a heavy hissing sound.

"Get the closed suction catheter!"

Lin Ye reached out and pressed down on the driver's head to prevent him from becoming agitated, then turned to Fang Rui beside him and gave him an order.

Fang Rui acted quickly, tearing open the aseptic packaging and rapidly connecting the negative pressure tube.

As soon as the tube was inserted into the airway through the tracheostomy tube, a thick layer of pink foam instantly burst out inside the negative pressure bottle.

In just ten seconds, more than half a bottle of thin bloody fluid was drawn out of the drainage tube.

"It's not completely suctioned out!" Fang Rui gripped the suction tube. "We just removed one layer, and it immediately pushes back up from below. The airway resistance is too high!"

It's not just that it can't be completely cleaned.

Less than half a minute after the suctioning was completed, the pink, frothy, bloody sputum began to ooze out from the metal interface of the tracheostomy tube like boiling water.

The microvessels were blocked by a large number of broken red blood cell fragments, the permeability of capillary endothelial cells completely collapsed, and plasma components poured back into the alveolar cavity like a torrential rain.

This body is being drowned alive by the blood melting in its own veins.

Nurse Zhao deftly disconnected a vial of budesonide and ambroxol suspension for inhalation, connected it to the nebulizer tubing, and looked up at the monitor:

"Oxygenation has dropped to 76%! Even with 100% pure oxygen, it can't be brought back down. All the surfactant in the alveoli has been washed away. We need to do plasma exchange immediately to filter out all the toxins and red blood cell fragments from the body!"

"What can we use for the exchange?" The attending physician asked, his hands in his white coat pockets. "A single plasma exchange requires at least two thousand milliliters of fresh frozen plasma. The blood transfusion department can't even get two bags of blood available. The city blood bank's trucks are stuck in the river tunnel and on the bridge, unable to move. Even if we bring the machine over, we can't cook without rice."

The air was so heavy it was hard to breathe.

Deep in my vision, the countdown didn't stop despite the danger to my airway; the numbers were silently decreasing.

【01:34:40】

【01:34:39】

There is less than an hour and a half left.

If they had waited for the city's blood bank's refrigerated truck to overcome the cross-river congestion, the person would have already suffered brain death from oxygen deprivation an hour earlier.

Conventional treatment pathways have been completely shut down by reality.

Lin Ye took a half step back, his gaze sweeping over the blood purification machine beside the bed before landing on the list of spare medicines.

Since the blood bank cannot provide foreign plasma, what extracorporeal circulation really needs is to remove those lipid-soluble toxins and maintain the disrupted colloid osmotic pressure.

How much human serum albumin is left in the pharmacy's inventory?

Lin Ye suddenly turned to look at the attending physician.

The attending physician paused for a moment, then said, "Albumin? We can definitely get twenty or thirty bottles from our regular stock. But that's for increasing colloid osmotic pressure; right now it's poisoning and hemolysis, we need to replace the plasma!"

"Use albumin instead of plasma for continuous plasma filtration adsorption."

Lin Ye strode over to the instrument and pointed to the spare port on the blood filtration machine:

"A neutral macroporous resin adsorption tank is connected after the pipeline. The leaked refrigerant additives are all fat-soluble organic substances, and the resin pores can lock them tightly inside the tank. Ultrafiltration removes some of the toxins carrying free hemoglobin, and the remaining liquid is replenished with an equal amount of albumin diluent. It not only removes toxins but also uses high colloid pressure to forcefully pull the water that has flowed back into the alveoli back into the blood vessels!"

The ward fell silent for a moment.

The attending physician's medical record paused in mid-air, and his gaze towards Lin Ye changed.

This combination of displacement and adsorption is an extreme compensatory approach in the field of critical care, and it has usually only been tried in research cases of fulminant hepatic failure.

To dare to use blood directly when the blood bank is cutting off supplies, one must have an extremely thorough understanding of the pathology and pipelines.

"The plan works, but the system won't allow it." The attending physician's brow was furrowed deeply. "Human serum albumin is strictly controlled. Approving twenty bottles at once is considered an overdose. Without a family member's signature, the pharmacy director wouldn't dare open the lock. Who would be responsible if the medical insurance system investigated?"

"The medical affairs department is responsible."

The sensor-activated glass door of the monitoring room slid open silently.

Liu Zhenhua, wearing a dark gray jacket, stood by the door, holding a briefing on the accident scene that he had just retrieved from the administrative duty room, his expression cold and stern.

"The treatment of victims of major public safety accidents shall be governed by the Emergency Regulations on Public Health Emergencies. The right to life takes precedence over the limitations of routine medication; everything is for the purpose of saving lives."

Liu Zhenhua strode in, pulled out a pen, and neatly signed his name on the special medication requisition form that the attending physician had spread out:

"The medical affairs department provides full support, and the clinical treatment plan is entirely decided by the rescue team. If any administrative or auditing issues arise, I, Liu Zhenhua, will submit the relevant materials to the Health Commission and the Medical Insurance Bureau."

He looked up at Lin Ye and said, "Go get the medicine. Go ahead and do it."

"Fang Rui, push the transport cart and come with me to the pharmacy to pick up the medicine!"

Nurse Zhao grabbed Fang Rui.

Fang Rui immediately grabbed the medication receipt and followed Nurse Zhao as they rushed out of the emergency room.

Three minutes later, two refrigerated plastic crates filled with twenty vials of 20% human serum albumin injection solution were placed heavily on the treatment table.

Prepare replacement fluid, install a large-pore plasma separation membrane, connect a special neutral resin adsorption tank in series, and pre-purge with heparinized saline.

The intensive care unit staff were extremely efficient.

As the machine's deep humming motor resumed, the dark red blood in the dual-lumen dialysis catheter was steadily drawn out and flowed into the adsorption tank through the transparent tube.

After being trapped by the resin micropores and ultrafiltered by the separation membrane, the waste liquid containing pungent organic residue is slowly dripped into the waste liquid bag below. In its place is a pale, clear yellow albumin saline replacement solution, which is slowly pumped back into the body by the warming device.

Ten minutes passed.

The powerful colloidal osmotic pressure of hypertonic albumin quickly takes effect, the osmotic pressure in the blood vessels rises, and the exudation in the alveolar cavity is gradually stopped.

Fang Rui inserted the closed suction tube again, and the foam that was suctioned out had changed from bright red to a very light pink watery liquid. The airway high pressure alarm dropped from 42 to 31 cmH2O.

The pulse oximetry reading on the monitor slowly and laboriously climbed back up from 76% to 88%.

The attending physician let out a long sigh and raised his hand to wipe the cold sweat from his neck.

The number that had been jumping wildly at the edge of my vision finally slowed down completely at the position of [01:10:05].

However, just as the heartbeats of several people in the ward had begun to stabilize—

A sharp metallic scraping sound suddenly came from the base of the special blood purification machine that was running next to the bed!

Beep—beep—beep—!

A high-decibel fault alarm red light suddenly flashed wildly on the top of the machine!

On the control screen, the previously smooth pressure curve suddenly jumped upwards to an almost vertical straight line, and a bold, blood-red English warning instantly locked the entire touchscreen:

【TMP High Limit Alarm!】

[Transmembrane pressure extremely high alarm! Filter immediately shuts off!]

Inside the transparent plasma separator, tens of thousands of tiny pores were completely sealed off by a dense mass of dark black blood clots and fragments of red blood cell membranes within just half a minute.

The blood in the tubing was visibly turning black and thickening.

"The filter membrane is completely clogged!" Fang Rui exclaimed. "There are too many fragments of red blood cells in the body, clogging all the pores! The machine needs to be stopped forcibly. If the blood doesn't rush out, all the blood in the entire pipeline will clog and become unusable inside the machine!"

The machine's alarm was almost piercing their eardrums, and the driver's blood pressure plummeted again as extracorporeal circulation was blocked.

Lin Ye stepped forward and grabbed two syringes of high-concentration heparin saline from the treatment tray beside the bed.