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

"How long has this been going on?"

Lin Ye held the phone while writing the forecast on the arrival board with his other hand.

"Twenty-six minutes. The patient remained conscious throughout and did not faint. Currently, the blood pressure is 118.74, the oxygen saturation is 99%, and the patient complains of palpitations, but there is no chest pain or difficulty breathing at the moment."

What did you do before being admitted to the hospital?

"They've only taken him under monitoring; he hasn't started medication yet."

"If their blood pressure and consciousness are stable, keep an eye on them. Report back immediately if anything changes."

He hung up the phone, cleared out the No. 1 resuscitation bed, and instructed the nurse to connect the defibrillator and monitor, and prepare the necessary equipment for a 12-lead electrocardiogram and intravenous access.

Lin Ye pointed to the bedside.

"Put the defibrillation patch aside for now, don't rush to apply it. The patient is currently stable, so treat it as stable tachycardia. Also, prepare the pressure gauge and leg support needed for the modified Valsalva maneuver."

The bedside nurse brought over the equipment, and another nurse checked the oxygen and resuscitation supplies.

Zhou Min passed by the emergency room, listened to the announcement, and stopped by the bedside.

Is your blood pressure stable?

"Stable condition, conscious, no chest pain, fainting, or difficulty breathing. Upon arrival at the hospital, perform a core electrocardiogram first. If the condition remains unchanged, proceed with vagus nerve stimulation."

"You answer first. Call me if you need medication."

The ambulance arrived at the door one minute early.

Twenty-nine-year-old Xu Xiao lay on the transfer bed, his right hand pressed against his chest, the monitoring wires on his chest swaying gently with the movement of the bed.

He could answer the doctor's questions in the ambulance without any difficulty breathing, but his forehead was covered in sweat.

"Doctor, is my heart going to stop?"

"Your blood pressure and consciousness are stable now. Your heart is beating fast, but it's still functioning effectively." Lin Ye walked towards the emergency room on the transfer bed. "Let's try to get the rhythm back on track first. Does your chest hurt? Are you short of breath?"

"It's pounding so hard, like it's going to jump out of my throat. My chest doesn't hurt, and I'm not out of breath."

The bedside nurse connected the patient to in-hospital monitoring; the heart rate fluctuated between 189 and 194. Blood pressure was 116-172, and blood oxygen was 99.

The 12-lead electrocardiogram was printed out quickly.

Lin Ye placed the one in front of the courtyard next to it for comparison. The rhythm was regular, the QRS complex was narrow, and there were no new dangerous changes for the time being.

Has this happened before?

Xu Xiao recalled for a moment.

"Two or three times before, my heart would beat fast for a while and then stop on its own, the longest being only three to five minutes. This time, it didn't stop, so my colleague called an ambulance."

Do you have heart disease or asthma? What medications do you usually take?

"No, and I don't take any medication regularly."

"Has anyone in your family died suddenly at a young age for unknown reasons? Have you taken any diet pills, cold medicine, energy drinks, or other stimulants in the past few days?"

Xu Xiao shook his head.

"I don't have any at home. I haven't taken any diet pills either. I've just been drinking a lot of coffee these past few days because I'm rushing to finish a project."

Lin Ye noted in the "Causes" column that his recent coffee intake had increased.

He had Xu Xiao remain in a semi-reclining position and handed him the air tube and pressure gauge to the bedside.

"Let's try a method without medication first. Blow hard as I say, and when the time is up, lie flat. The nurse will lift your legs. Don't stop on your own in the middle."

Xu Xiao stared at the pressure gauge.

"How hard do you want me to blow?"

"Can you maintain a mercury level of 40 mmHg for 15 seconds?"

"able."

He took the tube into his mouth and began to strain. His cheeks quickly turned red, and the veins on the side of his neck became visible.

The nurse was counting off, and Lin Ye's gaze fell on the rhythm of the monitoring screen.

"Twelve, thirteen, fourteen, fifteen. Lie flat."

Two nurses quickly lowered the head of the bed and raised Xu Xiao's legs to about 45 degrees.

Lin Ye instructed them to maintain the position for fifteen seconds. The heart rate on the monitor dropped briefly, the notification sound slowed down by two beats, and then returned to around 190.

Lower your legs and adjust the head of the bed back to a semi-reclining position.

Xu Xiao took a breath and his first reaction was to listen to the monitor.

"Didn't come down?"

The monitoring alerts quickly became more frequent again.

Lin Ye held on to the bed rail.

"Not yet. Take a breath first, and we'll prepare for the next step."

Xu Xiao's Adam's apple bobbed.

"Are you going to electrocute me next?"

"You don't have low blood pressure, altered consciousness, or persistent chest pain right now, so we won't use electrical cardioversion for now. We'll administer a short-acting medication first. You might experience chest tightness, fever, or a feeling of your heart stopping briefly when you take the medication; this sensation usually passes quickly."

"Did your heart skip a beat?"

"Monitoring and resuscitation preparations are in place; we will keep a close eye on you."

Lin Ye rechecked the patient's history of severe asthma, allergies, and recent medications.

Blood return was smooth in the proximal venous access, and the bedside nurse prepared medication and saline solution to flush the tube.

Zhou Min walked to the bedside and checked the electrocardiogram and contraindications.

"Administer 6 mg of adenosine via rapid intravenous push, followed by a rapid flush of 20 ml of normal saline. Continuously record the ECG; prepare for resuscitation and do not withdraw."

Lin Ye raised his hand to signal the nurse to wait a moment.

"Did you hear clearly what I just said about the discomfort?"

Xu Xiao licked his dry lips and placed his palm flat on the bed sheet.

"Listen carefully. Come on, if you keep jumping like this, I can't take it anymore."

Zhou Min checked the monitoring and access routes.

"Begin administering the medication."

The bedside nurse quickly injected adenosine through the proximal intravenous line, and another nurse immediately connected 20 ml of normal saline to flush the line. The monitor's beeps suddenly mingled together, and Xu Xiao's brows furrowed instantly, his chest heaving.

"I feel stuffy, my chest feels very stuffy."

"The medicine has been administered. Keep breathing, you'll be there soon."

Lin Ye stood by the bed, his gaze never leaving the rhythm.

The waveform on the monitoring screen paused for a very brief moment.

Xu Xiao opened his eyes wide, but before he could speak, the next set of waveforms reappeared.

The notification tone slowed down.

One hundred and twenty-six.

One hundred and four.

Ninety-two.

The bedside nurse reported the blood pressure.

"One hundred and fourteen, seventy, conscious."

Xu Xiao kept staring at the screen, his breathing becoming deeper than before.

"Just now, I really thought I was going to die."

Lin Ye leaned closer to the bedside.

"The medication's effect is very short-lived, and the rhythm has returned. Is the chest tightness still there?"

Xu Xiao took two breaths and shook his head.

"It's gone. My heart isn't pounding in my throat anymore."

The follow-up electrocardiogram printout showed a heart rate of 91 beats per minute, indicating that sinus rhythm has returned.

Lin Ye put the two electrocardiograms together.

"Have you been staying up late a lot lately? What about coffee, alcohol, and energy drinks?"

"I'm a designer for Google, and I've been rushing to finish the design these past few days."

Xu Xiao stretched his aching shoulders.

"I slept for four hours last night, drank two cups of strong coffee this morning, and didn't touch any alcohol or energy drinks."

"Make a note of the coffee and staying up late, but we can't determine the reason based on those alone right now."

Lin Ye instructed the nurses to continue drawing blood to check electrolytes and other parameters, and also asked the cardiology department to assess the subsequent examination and treatment arrangements.

"It's already been transferred back, should we keep it?"

"It needs to be observed. We still need to review the follow-up electrocardiogram, laboratory tests, and the cardiologist's opinion. This has happened several times before, and this time it lasted for a long time, so we need to evaluate the mechanism of the attack and the treatment plan."

Xu Xiao lowered his hand from his chest.

"The previous times it stopped on its own, and I always thought it was just heart palpitations from staying up late. If it happens again this time, will I have to call an ambulance again?"

Lin Ye realigned the two electrocardiograms.

"If you experience chest pain, fainting, difficulty breathing, or if the attack persists without relief, call for help immediately. Don't try to work through it, and don't take any medication on your own. We can't draw conclusions based on your description alone, just because the previous attacks were similar to today's. The cardiologist will combine the number of attacks and the electrocardiogram to tell you how to assess the situation."

"Could my previous encounters have been the same as today's?"

"Possibly. If it happens again, note the start time, and if possible, keep a record of your heart rate or ECG at that time."

The bedside monitor is still working, with beeps coming in even intervals.

Xu Xiao listened for a moment: "Now it's over ninety, it's really slowed down, right?"

"It's sinus rhythm now."

Xu Xiao leaned back against the pillow, his chest finally no longer rising and falling with each heartbeat.

Lin Ye clipped the follow-up electrocardiogram into the record book at the foot of the bed and instructed the nurse to continue monitoring blood pressure and rhythm.

Someone pressed the call button on another bed in the emergency room.

He had just turned around when Zhou Min came in from outside the door.

"Have the bedside nurse watch over there for now. Director Qin is looking for you. The residency training program is finished, and everyone is in the office waiting to be grouped."

"Standardized residency training grouping? Now?"

"Just a few minutes. I'll call you if Xu Xiao changes."

The door to Qin Hai's office was open.

Three young doctors in white coats stood in front of the table, each holding newly issued rotation materials.

"There are three in this batch." Qin Hai turned the grouping watch towards them. "The formal rotation and assessment will follow the department's arrangements. In daily consultations, you will work with the doctors in each group first. If you encounter high-risk situations, report to your superiors immediately."

He first called out Lu Ze's name and asked him to go to the general clinic area to talk to the attending physician on duty that day.

Next was Tang Wen, who was assigned to the observation area, and her daily medical records were reviewed by Ma Hao.

Tang Wen turned to the page corresponding to the grouping table.

"Should patients consult with Teacher Ma before deciding whether to stay or leave the hospital?"

"We'll discuss routine re-evaluations with Ma Hao first. Admissions, transfers, and high-risk treatments will be reported according to the department's procedures."

Qin Hai looked at the last person.

Fang Rui.

The young man on the right immediately responded.

"exist."

"You should start with Lin Ye, beginning with pre-hospital assessments and bedside initial consultations. If you're unsure, speak up promptly; don't try to handle it all on your own."

Qin Hai then turned to look at Lin Ye.

"Take him around to familiarize himself with the emergency area. Let him handle routine admissions first, and you'll be responsible for reviewing the cases. If you encounter high-risk procedures, report to Director Zhou as usual."

Fang Rui took half a step forward, holding the documents.

"Teacher Lin."

Lin Ye took the top pre-hospital visit report from his hand and handed it back.

Will the forecast be answered?

"meeting."

"You can answer the next call first."