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

The internal phone at the triage desk in the emergency department always rings without warning.

Nurse Zhao had just thrown the tissue she'd used to wipe her hands into the trash can when the triage nurse answered the phone. Her face instantly turned extremely serious, and she turned and shouted towards the emergency area, "Dr. Lin, 120 called for emergency services! They'll be there in five minutes! A 30-year-old construction worker was hit in the left chest by a misfired high-pressure nail gun!"

The relaxation in Lin Ye's eyes vanished instantly.

He strode towards the first bed in critical condition.

"Fang Rui, stop writing the medical records, prepare to receive the ambulance!" Lin Ye gave instructions as he walked. "Go get the bedside ultrasound machine, turn it on and warm it up. Sister Zhao, prepare two sets of large-sized intravenous catheters. Ma Hao!"

Ma Hao had just finished explaining things to the previous patient's family with Tang Wen when he heard the commotion and immediately rushed out, lifting the curtain of the observation area: "What's wrong?"

"Nail gun puncture wound to the chest, coming right away." Lin Ye pointed to the number two person next to him. "You and Tang Wen will be in charge of monitoring the ECG and establishing dual intravenous access. Fang Rui and I will be in charge of the airway and physical examination."

The piercing siren of an ambulance blared from outside the emergency room, growing louder as it approached, before finally screeching to a halt outside the reception gate.

Emergency responders pushed a stretcher and forced open the sensor door.

Lying on the flatbed was a young man in his thirties, wearing dusty work clothes. His face was ashen, and cold sweat streamed down his face.

He gripped the handrail of the flatbed cart tightly with both hands, panting heavily, his expression extremely agitated.

"I can't breathe... Doctor... I feel suffocated..."

The man's voice was hoarse, and his chest heaved violently.

"Patient Zhang Qiang, 31 years old, carpenter." The accompanying doctor quickly handed over the shift while running alongside the stretcher. "Twenty minutes ago, the high-pressure nail gun misfired, and a steel nail went straight into his left chest. We didn't dare to remove it on the spot, and the wound bled a little. His blood pressure has been dropping on the way here; it was 85-55 just now, and his heart rate is 125."

As the stretcher was pushed past the bed, Ma Hao immediately gave instructions: "Tang Wen, connect the ECG monitoring leads! Sister Zhao, insert the IV!"

Lin Ye took the scissors from Fang Rui and cut Zhang Qiang's work clothes and T-shirt from the collar down, revealing a large area of ​​his chest.

On the patient's left chest, near the heart, there was only a tiny black wound with a ring of gunpowder burn marks around the edge.

Apart from the initial drop of dark red blood that had already congealed, the surface of the wound was surprisingly clean, looking as if it had been forcefully pricked by the tip of a ballpoint pen.

There was no gushing blood, no horrific lacerations.

But Lin Ye's pupils suddenly contracted.

On both sides of Zhang Qiang's neck, the veins bulged high like two green earthworms, protruding across the surface of his skin.

"Her blood pressure is still dropping, 75, 50!"

Lin Ye quickly picked up the stethoscope and placed it on Zhang Qiang's chest.

The heartbeat coming through the receiver felt extremely distant and muffled, like a muffled drum being struck through a thick wall of water.

"Fang Rui, look at his neck!" Lin Ye shouted a warning.

Fang Rui leaned closer for a look, and his expression changed: "His jugular veins are bulging!"

"Distended veins, sudden drop in blood pressure, distant heart sounds." Lin Ye grabbed the ultrasound probe from the bedside, squeezed on some coupling gel, and exclaimed, "A classic case of Becker's triad!"

On the black-and-white ultrasound screen, a terrifying image suddenly appeared. The heart was surrounded by a huge, black, anechoic fluid-filled area. It was a large mass of accumulated blood.

On the free wall of the right ventricle, a thin, elongated shadow with a strong echo pierced through the myocardium.

"The steel nail pierced the right ventricle! Blood leaked into the pericardial cavity, causing acute cardiac tamponade. The heart collapsed due to the accumulated blood, unable to diastolic and unable to bleed!"

In that instant, at the edge of Lin Ye's vision, the air distorted like ripples on water. That pale blue halo, representing extreme danger, reappeared.

【07: 45】

【07: 44】

Lin Ye's breath hitched for half a second.

Less than eight minutes.

If the pressure in the pericardium cannot be relieved, the heart will stop completely.

"Tang Wen, draw blood immediately for blood matching, prepare for pressure infusion!"

Ma Hao decisively issued the order from the side.

Lin Ye whirled around, grabbed the internal phone on the resuscitation table, and dialed the second-line on-call room for cardiothoracic surgery. "Cardiothoracic surgery, emergency resuscitation bed number one! Penetrating cardiac injury from a nail gun, acute cardiac tamponade! There's no time to send him to CT and ultrasound departments. Immediately notify the operating room to prepare a chest-opening kit and cardiopulmonary bypass. The chief surgeon must come down immediately with a team!"

There wasn't a single word of nonsense on the other end of the phone, just a crisp "Coming right away," followed by the sound of a door slamming.

The monitor suddenly emitted a series of rapid, high-frequency alarm sounds.

"Lin Ye, your blood pressure has spiked!" Ma Hao shouted. "Sixty, thirty!"

Zhang Qiang rolled his eyes upwards on the bed, and his body, which had been struggling in pain, suddenly went limp and collapsed, completely losing consciousness.

【04: 10】

【04: 09】

The countdown is like a guillotine hanging overhead, descending irreversibly.

According to standard procedure, this type of penetrating cardiac injury requires immediate transport to the operating room for open-chest repair by a cardiothoracic surgeon. However, Zhang Qiang's current blood pressure is far from sufficient to reach the second-floor operating room; he might not even make it out of the emergency room. If he suffers cardiac arrest in the elevator, everything will be over.

We must be in the emergency room now, immediately drain the blood from the pericardium to relieve the pressure!

"Sister Zhao, get the pericardiocentesis kit! Prepare the adrenaline and atropine from the ambulance!" Lin Ye decisively gave the order. "I need to perform an emergency pericardiocentesis!"

Ma Hao was stunned for a moment.

Pericardiocentesis is a high-risk blind procedure. If not handled carefully, the needle can puncture the already damaged myocardium or even tear the coronary artery, leading to the patient's immediate death.

Usually only senior specialists dare to perform procedures in the emergency room.

But seeing Lin Ye's calm gaze that seemed to freeze the surrounding air, he swallowed back all the words he was about to say and turned around to fully cooperate in fixing the patient's position.

Nurse Zhao tore open the sterile puncture pack as quickly as possible.

Lin Ye put on sterile gloves, grabbed an iodine swab, and applied it extensively to the area below Zhang Qiang's xiphoid process and at the junction of his left costal arch.

He held the ultrasound probe in his left hand, re-locating the deepest point of the pericardial hemorrhage, and picked up the puncture instrument with a long needle in his right hand.

【02: 15】

"No one, don't move the bed."

Lin Ye took a deep breath, his voice low and steady.

He located the insertion point 1.5 centimeters to the left of the xiphoid process, with the needle tip at a 45-degree angle, aiming at the left shoulder, and inserted it into the skin with extreme composure.

As the needle pierced through the subcutaneous tissue and muscle, Lin Ye felt the changing resistance transmitted through the syringe.

On the ultrasound screen, a bright spot is steadily approaching the huge dark area.

The moment the pericardium wall was pierced, a distinct feeling of emptiness came from the fingertips.

Lin Ye immediately stopped advancing: "Fang Rui, come over and hold the probe, don't move it!"

Fang Rui took a deep breath and firmly held the ultrasound probe in both hands.

Lin Ye freed his left hand to firmly hold the syringe, and with his right thumb pressing against the end of the syringe, he gently pulled it back.

Dark red blood gushed from the needle into the syringe.

The blood, constantly churned within the pericardial cavity by the heart's beating, loses fibrin and becomes entirely non-clotting.

"It's out!"

Nurse Zhao stared intently at the transparent syringe.

Lin Ye exerted force with his fingers and quickly extracted a full fifty milliliters of dark red blood.

With the deadly blood clot removed, the heart, which had been tightly confined, finally gained a moment to breathe and began to beat with all its might.

"Blood pressure has risen!" Ma Hao stared intently at the screen. "Eighty, fifty... ninety, sixty!"

As his blood pressure rebounded, a very faint trace of color returned to Zhang Qiang's deathly pale face.

The countdown at the edge of Lin Ye's vision seemed to be paused when it reached 01:30. The numbers froze in mid-air before slowly fading until they disappeared completely.

The door to the emergency room was violently slammed open with a loud bang.

The deputy director of cardiothoracic surgery, accompanied by two assistants, rushed in, carrying a specialized emergency kit and covered in sweat.

"How is he?" the deputy director asked loudly.

Lin Ye placed the huge syringe filled with dark red blood in the curved tray and properly secured the indwelling catheter in Zhang Qiang's chest.

He looked up; his back was soaked with sweat.

"A steel nail pierced the right ventricle, causing acute cardiac tamponade. I performed a pericardiocentesis to decompress the blood and extracted 50 milliliters of non-clotting blood. The blood pressure is now around 90-60."

The deputy director glanced at the heart rate waveform on the monitor, which had regained its strength, then at the amount of blood accumulation displayed on the bedside ultrasound, and gave Lin Ye a deep look.

"Well dressed." The deputy director took over the bed immediately. "Now that the blood pressure is under control, transfer the patient to the operating room for open-chest surgery!"

Escorted by the crowd, the emergency bed sped out of the emergency room and headed towards the operating room on the second floor.

The emergency room corridor returned to a brief silence.

Lin Ye leaned against the empty railing of the emergency bed, breathing in the lingering smell of iodine in the air.

This was not only a rescue for the patient, but also a dual tempering of his neurological and technical skills as a formal resident physician.