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

After leaving Qin Hai's office, Fang Rui followed Lin Ye back to the emergency room.

Upon arriving at the nurses' station, he first checked the name tags and then flipped out the group assignment sheet to confirm them again.

Lin Ye led him to the nurses' station, pointing to the hospital's pre-hospital information board on the wall.

"Receive the forecast here first. After listening, don't rush to run. First, sort out the information that will change your current arrangements."

Fang Rui had just agreed when the phone at the triage desk rang.

The triage nurse said a couple of words and then raised her hand toward the emergency area.

"A patient suspected of having seizures has been transferred from the community clinic. The ambulance is in five minutes. We need to hand over the patient to the doctor before the hospital opens."

Lin Ye gestured for Fang Rui to come over.

How old is the patient? Are they conscious?

The person on the other end of the phone reported a 23-year-old woman.

More than forty minutes earlier, she had received an anti-nausea injection at the community clinic due to nausea and vomiting. Shortly after leaving, her eyes rolled upward, her neck turned to one side, and her jaw tightened.

She could still understand what was being said, her limbs were not twitching rhythmically, and her blood oxygen and blood pressure were temporarily stable.

"Has your voice changed? Can you swallow your saliva? Are you having any difficulty breathing?"

Fang Rui then asked the hospital staff to bring the medicine bag and prescription from the community clinic as well.

He hung up the phone and turned to look at Lin Ye.

"Shen Yan, a 23-year-old female, is conscious and her airway is currently open. She is not experiencing any rhythmic twitching of her limbs. Forty minutes after receiving the antiemetic injection, she developed abnormal neck and eye movements. I will first place her on the resuscitation bed, connect her to monitoring and intravenous access, and leave the suction device and bag valve at the bedside."

Lin Ye tapped on the empty medication section of the forecast form.

"What's missing here?"

Fang Rui followed that column down to sort through the information.

"Specific medication name and dosage. We also need to ask if you've been taking antipsychotic medication and if you've had similar episodes before."

"Go and prepare."

Fang Rui wrote three items on the headboard: conscious, abnormal posture, approximately forty minutes after the antiemetic injection. He checked the monitoring, intravenous access, and suction device with the bedside nurse, and then placed the bag-valve and airway equipment within easy reach.

"When the patient arrives, do not put anything in their mouth, and do not forcibly twist their neck."

The ambulance arrived faster than predicted.

When the back door opened, a young woman was half-lying on the transfer bed, her head uncontrollably turned to the right, her eyes constantly tilted upwards.

Her jaw was clenched so tightly that only intermittent breaths could be squeezed out from between her teeth, while her hands gripped the edge of the sheets.

The mother, who was in the car with him, held onto the car door; her voice was already hoarse from shouting.

"Doctor, she came out of the outpatient clinic like this. Did she have a seizure? Could she bite off her tongue?"

Fang Rui approached the transfer bed and leaned close to the patient: "Shen Yan, can you hear me?"

Shen Yan's eyes were still tilted upwards, but her right index finger tapped the bed sheet twice.

The bedside nurse took over the monitoring.

"Blood oxygen 98, heart rate 108, blood pressure 12276."

Fang Rui leaned down and listened to her breathing. There was no rattling sound, and no drool was coming out of her mouth.

He asked Shen Yan to try swallowing.

Shen Yan tapped the bed sheet with her index finger again, and then her throat moved.

Although her breathing was rapid, her chest rose and fell symmetrically.

Did you lose consciousness during the attack? Did your hands or feet twitch intermittently?

"No." The mother followed closely by the bedside. "Her eyes have been open the whole time. When I call her, she seems to hear me, but she just can't speak."

The accompanying doctor handed over a bag of medication from the community clinic: "Metoclopramide 10 mg intramuscular injection, administered about forty minutes ago. This is the only medication the clinic has given. No other medications have been used since the symptoms appeared."

"Does she take medication regularly? Has this happened before?"

The mother shook her head repeatedly, and several times she tried to straighten her daughter's neck, but the nurse stopped her each time.

Fang Rui circled the confirmed information on the admission form and then walked over to Lin Ye.

"She has remained conscious throughout, with no rhythmic twitching of the limbs, and her airway is currently clear. After metoclopramide, she experienced upward rolling of the eyes, neck twisting, and lockjaw, which I suspect is drug-related acute dystonia. She can still swallow, but the spasms persist; I would like you to confirm this as well."

Lin Ye came to the bedside, first listening to the breathing sounds, then checking the oral secretions and jaw movements.

Shen Yan was able to raise her hand as instructed, and although her gaze could not return to the center, she remained responsive to the sound.

He walked to the foot of the bed and dialed Zhou Min's number.

"Director Zhou, 23 years old, developed upward rolling of the eyes, neck twisting, and trismus after an intramuscular injection of metoclopramide. He is conscious and currently has no stridor, drooling, or hypoxia. I suspect acute dystonia."

"Proceed in this direction first," Zhou Min's voice came through the phone. "Don't remove the monitor and airway equipment. If swallowing worsens, there's stridor, or blood oxygen levels drop, call me immediately."

Lin Ye put away his phone and checked the medicine bag.

"Discontinue use of metoclopramide and record this drug reaction in the log. Maintain intravenous access and administer 20 mg of diphenhydramine intramuscularly."

The bedside nurse carries out the doctor's orders.

Shen Yan's mother stood at the foot of the bed, wiping her hands back and forth along the seam of her pants.

"Is she really not having a seizure?"

"Currently, it is more consistent with a muscle tone response caused by the medication. The airway is open, and we are monitoring swallowing and breathing. If the voice becomes more hoarse, completely unable to produce sound, or if there is stridor, drooling, difficulty swallowing, or difficulty breathing, we will immediately escalate the treatment."

Even after the medication was administered, Shen Yan's neck remained stiff on the right side.

Fang Rui stayed by the bedside, asking her to move her fingers every now and then.

A dozen minutes later, Shen Yan's tightly closed jaw loosened a little.

She tried to open her mouth and inhale, and after a while, her eyes gradually returned to the center, and the tense muscles on the side of her neck relaxed.

The mother took a step forward.

"Yan Yan, can you hear me?"

"I could hear it the whole time."

"I've been calling you, why didn't you answer?"

"I want you to stop shouting." Shen Yan moved her aching jaw, "but I can't move my mouth, and my neck won't obey me."

Her mother raised her hand to touch her, but was afraid of hurting her, so she only pulled the thin blanket that had slipped to the side of the bed up a little.

Fang Rui put the medicine bag into a transparent file bag and wrote down metoclopramide and the time of the attack in the bedside record.

Shen Yan moved her still slightly sore jaw: "Is this a drug allergy?"

"It's more like an acute muscle tone reaction caused by the medication, unlike common rashes or shortness of breath." Fang Rui showed her the record. "Remember the name of the medication and this reaction. In the future, when you go to the hospital to get medication, tell the doctor about it."

The mother carefully put away the medicine bag.

"Will you make the same mistake again?"

"We need to continue observing her." Fang Rui pointed to the call button next to the bed. "If she repeats the same action or shows any discomfort, press the call button immediately. Don't try to help her up yourself."

The mother turned the medicine bag over and stopped her finger next to the name of the medicine on the outpatient label.

"Was the injection at the outpatient clinic given incorrectly?"

"What we can confirm now is that the symptoms appeared after taking the medication, which is consistent with the adverse reactions that this type of drug may cause. Whether the medication was used incorrectly needs to be determined by considering why and how it was used at the time. Please keep the medicine bag safe for now."

Lin Ye wrote down the re-evaluation items in the observation record.

"Stay in the emergency room for now. Once your speech, swallowing, and neck movement are stable, and there is no recurrence during the observation period, we will assess whether you can walk."

Shen Yan nodded, and this time her movements were no longer stiff.

Fang Rui put the record back at the foot of the bed and checked the heart rate and blood oxygen before coming to find Lin Ye.

"There is no stridor, drooling, or difficulty breathing, and the abnormalities in the neck and eyes have subsided. I will remain under observation."

The triage nurse quickly brought over another patient admission form.

Lin Ye gestured to Fang Rui.

"Take a look at this first."

The triage nurse then handed the registration form to Fang Rui.