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

"Xu Xiao's follow-up electrocardiogram is in, showing sinus rhythm and no new ischemic changes. However, he has had recurrent supraventricular tachycardia in recent years, and this episode has lasted the longest. We recommend that he be hospitalized for Holter monitoring and electrophysiological assessment to determine the mechanism of the episode and the subsequent treatment plan."

"Hospitalization or outpatient follow-up first?"

"He's had several seizures in the past few years, and each time it stopped on its own. This time it took almost half an hour to get him transferred. The outpatient records alone aren't enough for a complete assessment. If you have a better idea of ​​what's going on, we can arrange a bed for him."

"I'll explain things to the patient first, then I'll get back to you."

Lin Ye hung up the phone and wrote the cardiology department's opinion into the consultation record.

The doctor on duty, surnamed Chen, carefully noted down the exact time he made the phone call and the specific time he recommended hospitalization before putting down his pen.

He flipped to Xu Xiao's blood pressure and electrocardiogram when he was admitted to the hospital and drew a line under "recurrent attacks and prolonged duration".

Xu Xiao currently has sinus rhythm and stable hemodynamics, so he doesn't meet the criteria for an emergency requiring immediate hospitalization.

However, the frequency of attacks is increasing and the duration of attacks is lengthening. If this continues, the attacks may not be able to resolve on their own next time.

A hospital stay for a comprehensive evaluation is more suitable than repeated visits to the outpatient clinic.

When Lin Ye walked to the bedside, Xu Xiao was pushing the monitor on the bedside table to the side to free his hand to look at his phone.

"Doctor, when can I leave?"

"Don't rush off." Lin Ye handed him the consultation record. "The cardiology department has reviewed your electrocardiogram and recommends hospitalization for a comprehensive evaluation. The previous episodes all stopped on their own, but this one has dragged on the longest. They want to find out the mechanism of the attack and see if medication or surgery is needed for a complete cure."

Xu Xiao put down his phone and frowned.

"How many days will I need to be hospitalized? I still have projects to finish."

"It depends on the examination schedule; it usually won't take too long." Lin Ye pointed to the monitor. "The main hospitalization is for Holter monitoring to track changes in heart rate during an attack. If necessary, electrophysiological studies will be performed to locate the abnormal discharge. Once the cause is clear, we'll know whether medication or surgery is the cure."

"What if we can't find out?"

"If we can't figure it out, we'll continue to monitor it with the monitor." Lin Ye pointed to the values ​​on the monitor and said, "The rhythm is stable now, but no one can say for sure when it will relapse next."

Xu Xiao stared at the consultation record for a while.

"Well... I'll tell my supervisor."

"I'll contact the hospital bed; you prepare the paperwork first."

Xu Xiao picked up his phone and then put it down again.

What if I do it again tonight?

"If it happens again, do as we said before: if you experience chest tightness, fainting, or difficulty breathing, call us immediately." Lin Ye moved the pager closer to him. "The monitoring and emergency preparations are right by the bedside. Don't stay up all night rushing to finish the project again."

Xu Xiao gave a wry smile.

"I don't dare to stay up any longer now."

Lin Ye returned to the examination table, and Nurse Zhu came over with a bed board for the emergency room.

"Dr. Lin, which bed should we reserve for the patient with chest pain? Xu Xiao is occupying the monitoring room, and bed number one is empty."

"The patient with chest pain will be placed in bed number one. Xu Xiao will remain under observation. The bed will remain in place. The monitor, electrocardiograph, and defibrillator will be prepared for bed number one. The items brought from the vehicle will be moved after the handover."

Nurse Zhu responded and turned to make the arrangements.

Lin Ye picked up the phone on the consultation table and dialed the cardiology department's on-call desk.

"Xu Xiao has agreed to be hospitalized. How will the bed be arranged?"

"I checked Xu Xiao's bed availability, and the cardiology ward is full today. He'll have to wait for a bed that will be available for discharge tomorrow morning. If you assess that he absolutely needs to be admitted tonight, I'll coordinate with the on-call supervisor; otherwise, he can be transferred first thing tomorrow morning."

Lin Ye glanced in the direction of Xu Xiao's bed.

"After cardioversion, he has maintained sinus rhythm, his blood pressure is stable, and he has not experienced any further discomfort. We will proceed with the transfer arrangements for tomorrow. I will complete the handover procedures for his observation period."

"Okay, then tomorrow."

What time will you transfer tomorrow?

"After 8 a.m., the emergency department will be notified if there is a bed available in the ward. Prepare the observation record and electrocardiogram report in advance, and have your nurse call to hand over the patient before transferring the bed."

"it is good."

Lin Ye put down the phone and added a line to Xu Xiao's medical record: Waiting for bed in the cardiology department, to be transferred to inpatient evaluation tomorrow.

He called over the nurse in charge of Xu Xiao's bedside.

"Xu Xiao will continue to be monitored tonight. If he experiences palpitations, chest pain, or a drop in blood pressure again, call me immediately. He will be transferred to the cardiology department tomorrow. I will fill out the handover form tonight and leave it at the nurses' station."

The nurse at the bedside responded and readjusted the monitoring parameters on Xu Xiao's bedside.

Lin Ye finished writing the handover form and then stopped writing.

Xu Xiao will be transferred to the cardiology department tomorrow. He filled in the remarks column with details about who dropped him off, who picked him up, and which pages of the monitoring records to bring before signing his name.

He had just clipped the handover form together when the triage nurse poked her head in.

"Dr. Lin, a patient with chest pain has arrived at ambulance bay number three. The pre-hospital electrocardiogram has already been sent over."

"Understood, send the person directly to bed number one."

Lin Ye stood up and looked at Nurse Zhu, who was checking the beds.

"Prepare the monitor and electrocardiograph, and place the blood collection tubes by the bedside. Once the patient arrives at the bedside and their identity is verified, we will issue the prescription."

"Okay." Nurse Zhu turned on the defibrillator screen. "I just did a self-check; the electrode pads are in the drawer."

Lin Ye tucked Xu Xiao's medical record into the to-do list and walked to the vehicle arrival board.

The pre-hospital electrocardiogram was not printed clearly, and the ST segment elevation was not only found on one lead.

It is present in the inferior wall and in the precordial leads, with the shape curving upwards, and there is no obvious depression in the corresponding leads.

He moved the paper closer to the lamp.

"How was it reported before hospitalization?"

"Chest pain for three hours, fever for two days. The pain is worse when lying down and taking deep breaths, and it gets a little better when sitting up." The triage nurse handed over the report form. "43-year-old male, blood pressure 122.76, heart rate 108."

"Treat high-risk chest pain first, don't give medication in advance." Lin Ye took the triage form. "Immediately repeat the 12-lead scan upon arrival at the bedside, and draw troponin, complete blood count, inflammatory markers, and liver and kidney function tests. Bring the bedside ultrasound over."

Nurse Zhu had already moved the monitor and electrocardiograph machine for bed number one into place, and the defibrillator was placed at the foot of the bed.

The ambulance had just backed into the parking space when the back door opened.

The pre-hospital doctor jumped out first: "Chest pain for three hours, low-grade fever, vital signs stable. We wanted him to lie down in the car, but he said it hurt more if he lay down."

The patient was helped onto the No. 1 resuscitation bed, and sat up straight with his hands supporting his knees. Only after his chest was off the headboard did his tense shoulders relax a little.

Nurse Zhu reached out to adjust the head of the bed, but he immediately waved her hand.

"Don't lay it flat, I'm more comfortable like this."

Lin Ye caught the monitor, his gaze lingering on the patient's firmly straight back.