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

On Sunday evening, Lin Ye stuffed his backpack into the locker, and the new key in the inner pocket made a soft sound as it touched the locker door.

Lin Ye zipped up his jacket and came out with Ma Hao after they changed into their white lab coats.

Nurse Zhao had just finished her day shift handover and was checking the handover form for the ambulance.

She opened the bottom drawer, checked the seal number, glanced at the oxygen cylinder pressure gauge, and finally ticked the form.

Ma Hao casually moved the empty stool blocking the car aside: "Sister Zhao, it's been a long time since we worked together."

"It's been a while." Nurse Zhao pushed the drawer back, her gaze lingering on Lin Ye's chest for a moment. "Did you get a new name tag?"

I received it last week.

"Finally, it's installed." She clipped the handover form back to the side of the vehicle. "Get back to work."

At the other end of the nurses' station, Sun Zhiqiang was flipping through the handover log, listening to the day shift doctor explain the follow-up examination time for the last patient.

Lin Ye swiped his card to log into the workstation, while Ma Hao picked up his tasks at the next workstation.

After 6:30, the day shift staff left one after another, and the emergency room was handed over to them for the night.

Lin Ye had just finished confirming a test that was about to be returned when Nurse Zhao's voice suddenly came from the triage desk.

"Don't get up! Sit still!"

A man in his fifties was sitting in a wheelchair, his hands supporting him on the armrests, his waist already off the seat.

The woman who accompanied him was carrying a black fanny pack, and her other hand was gripping his shoulder tightly.

"My legs are fine." The man moved forward further. "It's just that my benign paroxysmal positional vertigo (BPPV) is acting up. I've felt this dizzy before."

He reached out and grabbed the back of an empty chair next to him. Just as he stepped out with his right foot, his body suddenly lurched to the right, and the chair leg scraped against the ground with a screeching sound.

Nurse Zhao slammed on the wheelchair brakes and, together with the family, helped the person back home.

"Move the chair away first." She pushed the empty chair away. "If you really fall, it won't be able to catch you."

The man leaned back in his chair, still explaining, "I got up too quickly just now, I'm really fine sitting down."

Lin Ye had already walked to the wheelchair: "When did you start feeling dizzy?"

"Around five o'clock."

"What exact time was 5:00? What were you doing at the time?"

The man turned to look at his wife.

"Around 5:40," the woman remembered clearly. "He parked his car at the entrance of the community, and as soon as he opened the door, he slammed it against the door frame. It was the security guard who called me."

"What about before you got off the bus?"

"I didn't feel dizzy on the way." The man wiped his forehead. "As soon as the car stopped and I stood up, the sky started spinning. I've had repositioning done before, so I just need to lie down for a while."

Nurse Zhao released the brakes, pushed the wheelchair to the triage station, brought it to a stop, and then put the blood pressure cuff on him: "Are you feeling better now that you're lying down?"

"I lay there for almost an hour, but I still didn't feel better. When I got up, I felt extremely dizzy, and even sitting up made me feel a bit spun around."

The blood pressure monitor stopped working. Nurse Zhao read out the numbers: "162/98, heart rate 78, oxygen 98."

The man's name is Wu Jianping, he is 56 years old, he usually drives a ride-hailing car, he has high blood pressure, and he took his medicine on time this morning.

After asking these questions, Lin Ye returned to his diagnosis of benign paroxysmal positional vertigo (BPPV).

"Last time you had this flare-up, you felt dizzy even sitting still?"

"Pretty much, anyway, it turns as soon as it moves."

His wife shook her head beside him: "It's different. Last time, I only felt dizzy when I turned over or lifted my head. I just lay there and was fine. I could even walk by myself then. But today, I can't even stand up straight and I keep falling to one side."

Wu Jianping frowned: "They're both dizzy, how different can they be?"

"That's the difference." Lin Ye noted down the characteristics of previous attacks on the triage form. "This time, I feel dizzy even when sitting, and I can't stand steadily. It's not the same as last time. Don't rush to conclude that it's benign paroxysmal positional vertigo (BPPV)."

Nurse Zhao brought the bedside blood glucose meter.

With a soft click, the lancet released a drop of blood into the test strip, and the screen quickly displayed 6.4.

Lin Ye half-squatted in front of the wheelchair, making Wu Jianping stare at his fingers.

As his gaze shifted from left to right, both his eyes followed. Wu Jianping didn't actually see two eyes; however, when he looked to the right, his eyeballs exhibited a slight horizontal tremor.

"Do you have a headache? Is one side of your face feeling numb?"

"no."

"Do you speak normally? Is it difficult to swallow?"

Wu Jianping swallowed hard in front of him: "Everything's fine."

Lin Ye asked him to show his teeth and stick out his tongue, and then checked his upper limbs when he could raise them horizontally, his hand and foot strength, and his fingers and nose.

I can complete several movements, and there is no obvious difference between the left and right sides.

Having strong limbs doesn't mean that the slight rightward swerve just now is nothing to worry about.

Wu Jianping's phone vibrated again. He glanced at the caller ID but didn't answer: "The property management is urging me to move my car. Doctor, could you prescribe some medicine for me first? I'll get someone to come and help me move the car."

"You can call people, but you can ask others to move your car." Lin Ye gestured for him to hand the phone to his wife. "You can't even stand steadily next to a wheelchair right now, let alone touch the steering wheel."

Wu Jianping handed over his phone, still saying, "Just that one time, you guys help me up, I'll try it again."

Lin Ye didn't let him touch the empty chair.

Nurse Zhao stood on the right, while he stood on the left, supporting Wu Jianping's forearm, allowing him to slowly get up from the wheelchair.

Before Wu Jianping could even stand firmly on his feet, his shoulder had already tilted to the right.

Nurse Zhao was prepared; she supported his waist and pressed him back into the chair.

[Risk Gap: Both times he stood up, he tilted to the right, which cannot be explained by his previous history of benign paroxysmal positional vertigo (BPPV)]

Lin Ye watched as Wu Jianping gripped the handrail tightly again.

Both times it was in the same direction, so we can't just gloss over it with "I was in a hurry".

"Send him to the observation area first, near the nurses' station, and connect him to monitoring." He stood up. "He needs someone to accompany him even to the restroom; he can't get out of bed by himself."

"I'll keep an eye on it." Nurse Zhao released the brakes, turned the wheelchair around, and said, "Go and write the prescription."

Lin Ye returned to the workstation and wrote down the details of the sudden onset at 5:40, the persistent dizziness, the characteristics of previous attacks, and the obvious rightward deviation when standing up twice.

After submitting the electrocardiogram, urgent blood test, and monitoring orders, he immediately initiated an emergency consultation with the Department of Neurology, stating in the application that the patient was experiencing acute persistent vertigo, unable to stand independently, and that central nervous system lesions should be ruled out.

A notification popped up in the bottom right corner indicating that the signature was successful.

Sun Zhiqiang had just come out of the next consultation room when Lin Ye stood up and called to him, "Dr. Sun, could you please take a look? The patient suddenly started feeling dizzy at 5:40 and hasn't stopped since. He feels dizzy even when sitting. There are no obvious abnormalities in his limb strength, speech, or swallowing, but he leaned to the right twice when he stood up."

"What about your blood sugar?"

"6.4. Monitoring, electrocardiogram and emergency blood tests have been ordered, and an emergency consultation with the neurology department has also been requested."

Sun Zhiqiang closed the medical record folder in his hand: "Let's go, let's see the person first."

Wu Jianping's wife had already contacted his younger brother using his mobile phone and sent him the license plate number and parking location all at once.

After hanging up the phone, she stuffed it into her black waist bag: "Someone moved the car, so don't worry about it anymore."

This time, Wu Jianping didn't refute, but instead asked Sun Zhiqiang, who had walked up to him, "Doctor, I used to have benign paroxysmal positional vertigo (BPPV), and one repositioning procedure would have cured it. Is it the same today?"

Sun Zhiqiang did not answer according to the name of the illness.

He glanced at the attack time written by Lin Ye, and then checked the eye movements, hand and foot strength, and finger and nose movements by the bedside.

"You stood there twice just now?"

"Both times it veered to the right, and it would have fallen if I hadn't helped it up," Lin Ye replied.

Sun Zhiqiang looked down to confirm that the brakes were still engaged.

"Then let's not try a third time." He looked at Wu Jianping, "Sit still first. If you can't stand steadily, we'll have to check you again."

Wu Jianping opened his mouth, wanting to ask if a repositioning procedure would suffice.

Sun Zhiqiang turned to Lin Ye: "First, do a cranial CT scan. The neurosurgeon will see the patient as soon as he arrives."

"it is good."

Lin Ye returned to the work station and submitted an inspection request.

After submitting the request, he dialed the neurology department's on-call number again.

The call was answered quickly. There was a sound of a door opening on the other end. After confirming which observation spot the patient was in, the person only said, "I saw the application. Don't get out of bed yet, I'm coming now."

Lin Ye hung up the phone and looked up at the observation area.

Wu Jianping is still in a wheelchair.

This time, he kept both feet on the footrest and didn't touch the chair next to him.