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

When the three people were pushed into the emergency room, Qin Hai's first reaction was not to catch them.

He raised his hand to stop him.

"Don't push him into the emergency room yet."

The paramedics were taken aback.

The man on the flatbed was covering his head, his face was pale, and he was dry heaving.

The two coworkers behind them were supporting each other; one had red eyes, and the other kept coughing.

Everyone in the emergency room looked over.

The factory manager followed behind, still wearing his safety helmet, and his voice was louder than anyone else's.

"Doctor, hurry! They've taken a few breaths and are feeling dizzy and nauseous. Give them oxygen!"

Qin Hai glanced at him.

"What's wrong?"

The person in charge got stuck.

"It's the gas leaking from the workshop."

Nurse Zhao had already put on her gloves, but she didn't take a step forward.

She looked at Lin Ye.

Lin Ye stared at the three people's clothes.

The gray-blue work clothes had a damp, sour smell, mixed with a slightly pungent odor.

Unlike simple gas.

It doesn't smell like regular cigarette smoke either.

He looked at the heaviest one first.

The man on the flatbed was in his thirties, with heavy eyelids and slow reactions. His fingers gripped the bed railing, and his fingernails were full of black dirt.

The monitoring clip has just been put on.

Heart rate 126.

Blood pressure 10268.

Oxygen saturation is 98%.

The numbers don't look bad.

But the man's gaze was off.

It's like looking through a layer of fog.

Nurse Zhao said in a low voice, "The oxygen supply is okay."

There are no pine trees in the woods.

The system interface lights up at the edge of the field of view.

High-risk warning: Possible inhalation poisoning/hypoxic injury.

[Risk of misdiagnosis: common dizziness, gastroenteritis, fatigue.]

[Note: A normal pulse oximetry result does not rule out carbon monoxide poisoning.]

Lin Ye immediately looked up.

"Clear the hall first, move the three people to a well-ventilated area, and don't shake out their outer clothing. Is there any pungent odor? Are there any other people present?"

The factory manager was in a panic.

"Weren't they all delivered?"

Qin Hai's voice deepened.

"I asked if there was anyone left at the scene."

The person in charge took a half step back because of his gaze.

"There are two more people at the entrance who said they were fine and came by car."

Nurse Zhao's expression changed.

"Did you come by car?"

Qin Hai picked up the phone immediately.

"On-call supervisor: Suspected unidentified gas exposure in the emergency room; multiple people have arrived. Notify security, infection control, and emergency second line to reserve a ventilated isolation area. Contact the 120 command center to confirm if there are any other exposed individuals on site."

The person in charge turned pale.

"Is it that serious?"

Qin Hai pointed at the man on the flatbed cart.

"His reactions are slow now, do you think that's serious?"

The 120 doctor quickly filled in the medical history.

"The wastewater treatment room in the factory area was under maintenance. They said someone in the pump room was complaining of dizziness, and the person who went in to help them also felt dizzy. When we arrived, the windows were already open, and the smell had dissipated somewhat."

Wastewater treatment room.

Maintenance.

Those who went in to rescue people also fainted.

Lin Ye's heart sank.

These words together are more jarring than any system notification.

Hydrogen sulfide.

Carbon monoxide.

Oxygen-deficient environment.

Any one of them could be fatal.

He suppressed his thoughts and presented the evidence first.

"Confined space exposure, multiple people falling ill at the same time, and two instances of illness occurring after entering to rescue others. This cannot be treated as ordinary dizziness."

Sun Zhiqiang had just returned from the CT room when he heard this, and all his sleepiness vanished.

"Who is the heaviest?"

Nurse Zhao points to the stretcher.

"This one is slow to react. Another one has eye pain and coughing, and the third one is dizzy and nauseous."

Qin Hai quickly diverted traffic.

"The most severely ill patients will be taken to the negative pressure room next to the emergency room. The door will be open for ventilation, so there won't be any crowding. The patient with cough and eye pain will have their eyes rinsed first, and their airway will be checked. The third patient will be placed on a bed for monitoring. Everyone will be given high-flow oxygen first. Arterial blood gas will be drawn, and carboxyhemoglobin, lactate, electrolytes, and cardiac markers will be added. An electrocardiogram will be performed."

Nurse Zhao repeated the instructions and then turned around to make the arrangements.

The factory manager wanted to go inside as well.

The security guard stopped him.

He was sweating profusely with anxiety.

"I'm in charge, I have to keep an eye on things."

Liu Zhenhua's voice came from behind him.

"What you should be looking at right now is the list."

The person in charge turned around.

Liu Zhenhua had already arrived, holding a notebook.

"How many people were on site at the factory? Who went into the pump room? Who was waiting outside? Who came to the facility on their own? Who went home? Names, phone numbers, and exposure times. Write them down now."

The person in charge opened his mouth.

"I……"

Liu Zhenhua handed over the pen.

"If you can't write it, just call someone who can and have them write it down."

In the emergency room, the heaviest man was transferred to a resuscitation bed.

His chest was barely rising and falling, and his eyes were half-open.

Lin Ye leaned over.

"Can you hear me? What's your name?"

The man's lips moved.

"Zhou... Zhou Wei."

"How long have you been in the pump room?"

Zhou Wei reacted very slowly.

"Old Ma... he's fallen... I'm going in to pull him up..."

"How long will you be inside?"

"I don't know... just for a little while..."

For a while.

The most dangerous thing in the emergency room is this brief moment.

Sometimes "a while" means two minutes.

Sometimes enough for a person to collapse inside in a short time.

Nurse Zhao fastened the oxygen mask.

High-flow oxygen was rushed in, and a layer of white mist quickly formed on the plastic mask.

Sun Zhiqiang applied the electrocardiogram patch.

"The electrocardiogram showed no obvious ST segment elevation, but the heart rate was fast."

Lin Ye noticed that the blood and qi test results hadn't come out yet, so he touched Zhou Wei's hand first.

My skin isn't cold.

There was no obvious cyanosis.

But people are just slow.

It feels like someone is holding my head down.

The system notification jumped to another line.

[Risk increased: Progression of consciousness impairment.]

The coworker in the next bed, whose eyes were red, was coughing more and more violently.

My throat is burning and my eyes hurt.

Nurse Zhao rinsed his eyes.

"Don't rub it."

The man was crying and cursing at the same time.

"I told him not to go in, but Old Ma fell inside, and he insisted we pull him out."

The factory manager, who was outside the gate, heard this and turned even paler.

Qin Hai turned around.

"Where's Lao Ma?"

The coworker was stunned.

"Wasn't it delivered?"

There was a moment of silence in the emergency room.

Lin Ye looked at Doctor 120.

The 120 doctor's expression changed as well.

"We received three people. They said the heaviest one had already been moved to a well-ventilated area by our colleagues, but who got on the vehicle later...?"

Before he could finish speaking, Qin Hai had already picked up the phone.

"120 command center, confirm if there is still a worker named Lao Ma at the factory site. Suspected gas exposure in a confined space, there may still be injured people left behind."

The person on the other end of the phone immediately got busy.

Liu Zhenhua walked directly to the door.

Where is the factory manager?

The person in charge's legs went weak.

"Old Ma, Old Ma might have recovered on his own..."

Liu Zhenhua slammed the notebook in front of him.

"Two words might not be enough to save someone."

The blood and qi results came out.

Lin Ye took the order, his pupils contracting slightly.

Lactic acid levels are elevated.

Metabolic acidosis.

Carboxyhemoglobin is also high.

It's not as simple as just a single irritating gas.

"Director Qin, your carboxyhemoglobin and lactate levels are both high."

Qin Hai took the order.

"Carbon monoxide exposure cannot be ruled out. Wastewater pumping stations should also be wary of hydrogen sulfide and oxygen-deficient environments."

Sun Zhiqiang frowned.

"Then a pulse oxygen level of 98 is meaningless."

Qin Hai nodded.

"That's the meaning."

He passed the list to Lin Ye.

"Add it to the list. Normal oxygen saturation does not mean there is no poisoning."

Zhou Wei suddenly became agitated.

He raised his hand to pull off the mask.

Nurse Zhao grabbed him and held him down.

"Don't pick it!"

Zhou Wei's eyes were fixed on the screen.

"I want to...go back...Old Ma..."

Lin Ye held onto the bed railing.

"You can't go back now. Old Ma will have someone looking for you. You should use oxygen first."

Zhou Wei wouldn't listen; he struggled so much that the monitoring cable swayed.

Heart rate 140.

Qin Hai immediately gave the order.

"Restrain and protect the patient to prevent falls from the bed. Continue high-flow oxygen therapy. Notify the emergency intensive care unit and contact the hyperbaric oxygen therapy team on duty, explaining that the patient has been exposed to a suspected combination of carbon monoxide and an unidentified gas, and has experienced altered consciousness."

Nurse Zhao cursed as she secured the device.

"To save lives, you must first save the living."

The call to the hyperbaric oxygen therapy department was answered quickly.

After hearing about the carboxyhemoglobin and altered consciousness, the other person's voice tightened.

"Continue with high-flow oxygen and assess vital signs. If conditions are met, switch to hyperbaric oxygen as soon as possible. For those who are unconscious, ensure airway and circulation first. We must confirm safety before opening the chamber."

Qin Hai hung up the phone.

"Take on emergency critical cases first. Whether hyperbaric oxygen therapy is possible depends on vital signs and specialist evaluation."

Footsteps sounded outside the door again.

The two workers who arrived by car were taken to the emergency room entrance by security guards.

One said they had a headache.

One person said they felt tightness in their chest.

They wanted to go into the hall.

Nurse Zhao called out through the door.

"Stop! Don't wander off!"

The two workers were startled.

"We're fine, just a little dizzy."

Nurse Zhao was wearing a mask, and her voice was cold.

"Emergency room staff are the least likely to believe the words 'I'm fine'."

Qin Hai looked at Sun Zhiqiang.

"Open two more observation beds in the triage area. Register all those exposed at the same time, provide oxygen, monitor them, and draw blood gases. Don't let anyone go home to sleep."

Sun Zhiqiang nodded.

"clear."

Liu Zhenhua's phone call finally went unanswered.

He listened for a few seconds, then his face darkened.

"There is another worker at the scene, Ma Jianguo, 56 years old. His colleagues said he has recovered and is now sitting in the factory gatehouse. He did not get into the ambulance."

Qin Hai cursed directly.

"Sit down?"

Liu Zhenhua had already turned around.

"Two ambulances have already gone to pick us up. The emergency management department has also notified us."

Qin Hai looked at the list on the wall.

The postpartum pulmonary embolism regulations were just posted there.

The blank space below seems to be waiting for this line.

Lin Ye picked up his pen.

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, on-call staff, infection control/security, 120 command center, hyperbaric oxygen therapy department, and emergency response departments if necessary.

When he wrote "Don't just look at the pulse oximetry," Zhou Wei's monitor beeped again.

Heart rate 152.

My consciousness is even more confused.

Qin Hai stood by the bed.

"Assess the airway. Also, have the anesthesiology department on standby."

Just as Lin Ye picked up the phone, a call came back from the 120 emergency center.

"Director Qin, Ma Jianguo suddenly collapsed at the scene. Two vehicles are transferring him and are expected to arrive in six minutes."

Qin Hai's face darkened completely.

The system notification finally popped up.

[Sixth night, additional high-risk case confirmed.]

The risk of group inhalation poisoning is increasing.

[Critically ill patients who have not yet arrived at the hospital: Countdown 06:00.]

Lin Ye stared at the countdown, his fingers tightening.

The ink on the new list on the wall was still wet.

Outside, the ambulance sirens were already blaring again.