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

"Bang!"

Two hundred joules of biphasic electric shock were released, causing the driver's body to bounce violently up before crashing back down.

Lin Ye pressed his hands firmly against the electrode plates, staring intently at the monitor.

After a brief period of flattening, the ventricular tachycardia waveform struggled to produce several wide and distorted QRS waves. The heart rate dropped back to 110 beats per minute, but remained erratic.

"Fang Rui, administer 10 ml of calcium gluconate slowly via bolus, and add 5 units of insulin intravenously for high glucose!"

Lin Ye pushed the electrode plate back into the slot.

"Defibrillation is only an emergency measure; the blood potassium level must be lowered, otherwise ventricular fibrillation and cardiac arrest could occur at any time!"

Fang Rui used one knee to brace himself against the aisle and quickly pushed in calcium gluconate.

The towering T waves on the monitor finally shortened by a few millimeters, but the blood pressure was still as low as 70/45 mmHg.

The on-site amputation and blood loss, along with the large amount of myoglobin released from severe compression, have pushed the injured person to the brink of multiple organ failure.

"Waaaaah!!"

The ambulance screeched as it plunged into the emergency room of the First Municipal Hospital.

The back door was slammed open from the outside, and a strong smell of disinfectant hit us.

"Arrival! One patient, suffering from severe crush injuries complicated by traumatic amputation!"

As Lin Ye jumped out of the vehicle, he ripped off his breathing mask. The edge of the mask left purplish-red marks on his cheekbones, and sweat dripped down his chin onto his grime-covered rescue vest.

When Ma Hao and Nurse Zhao, who came to greet them, saw the person on the stretcher, their pupils contracted sharply at the same time.

The body was covered in black ash, smelled of diesel fuel, and had a pungent odor of phosphoric acid trichloride mist residue.

The right groin was wrapped in a thick tactical dressing, and dark red blood had soaked through two layers of bandages. The air was filled with a stench of burnt flesh mixed with rusty iron.

"Move to bed number one in the red zone! Immediately put on the pressure transfusion and warming machine!"

Ma Hao pushed the flatbed cart brakes open and, together with Fang Rui, pushed the person into the emergency room.

The hall was already in complete chaos.

The first batch of injured from the major car accident in the tunnel have been delivered, and groans and sirens calling for doctors filled the air.

But as this charred and severely injured patient was wheeled in, almost all the medical staff in the emergency red zone rushed over within three seconds.

"Reconnect ECG monitoring! Insert central venous catheter! Sister Zhao, prepare the femoral vein double-lumen catheter!"

Lin Ye grabbed the stethoscope and pressed it against the driver's chest.

Coarse breath sounds in the left lung, accompanied by numerous crackles, and extremely faint breath sounds in the right lung—the standard signs of inhaled chemical pulmonary edema.

"Arterial blood gas is coming out!"

The intern nurse jogged along to pat the thermal paper onto the treatment cart.

Lin Ye, Ma Hao, and the deputy director of the intensive care unit who rushed over peeked in and their faces all darkened.

pH value: 7.08

Serum potassium (K+): 7.8 mmol/L

Lactic acid (Lac): 9.1 mmol/L

Alkali excess (BE): -16.5 mmol/L

Myoglobin: >4000 ng/mL

"This is a textbook example of severe crush syndrome with systemic inflammatory response."

The deputy director of the intensive care unit pushed up his glasses, his fingers tapping loudly on the cold table:

"A large number of necrotic muscle cells disintegrate, and potassium ions and myoglobin rush into the kidneys like a mudslide. If bedside hemodialysis isn't started immediately, acute renal failure and malignant arrhythmias will occur within twenty minutes, and no one can save him!"

"I'll install the dialysis catheter!"

Lin Ye put on sterile gloves and grabbed a gauze pad soaked in iodine to disinfect a large area:

"Fang Rui, get the large-sized needle, prepare for ultrasound-guided injection into the right internal jugular vein, leaving a pathway for the blood transfusion warmer!"

"Yes!" Fang Rui gritted his teeth and skillfully put on the probe cover.

The puncture needle was inserted into the femoral vein with precision and force, and the dark red blood was smoothly aspirated.

Guidewire placement, skin dilation, advancement of the double-lumen dialysis catheter, and suture fixation.

Lin Ye's hands were as steady as a machine, and in less than four minutes, the No. 12 double-lumen cannula was successfully inserted. The hemodialysis machine beside the bed whirred as it connected to the tubing, and dark red blood was drawn out and flowed into the rolling filter.

However, an even bigger crisis erupted at the foot of the bed.

The deputy director of the second-line orthopedics department and the chief resident of the vascular surgery department rushed into the red zone almost simultaneously. They lifted the dressing on the stump of the thigh and took a look. Their faces were ashen.

"The bone ends are jagged, the surrounding muscles are full of necrotic tissue contaminated by diesel and chemical fumes, and the collateral veins are bleeding extensively."

The deputy director of orthopedics looked up at Lin Ye:

"We must immediately take her to the operating room to widen and repair the wound at the bone ends to close it; otherwise, it will lead to gas gangrene and sepsis!"

"How do we perform the surgery? Let's check the blood clotting!"

The vascular surgery on-call supervisor slapped the lab report onto the orthopedic surgeon's chest:

"PT extended to 28 seconds, fibrinogen levels are down to 0.8, early stage of DIC! If the blood vessels relax during general anesthesia induction, the wound will bleed out like a sponge, and the person will definitely die on the operating table!"

"So we'll just leave it here to rot?"

The air in the emergency room was so tense it was almost freezing.

Surgeons wanted to operate, anesthesiologists dared not take over, internal medicine doctors were desperately fighting off shock, and multiple disciplines were fiercely clashing at the bedside of critically injured patients.

"If radical surgery is not feasible, a damage control surgical strategy should be implemented!"

Lin Ye took off his blood-stained rubber gloves, his voice clear and resounding in the noisy emergency room.

The orthopedic surgeon and the vascular surgeon both turned to look at him.

"The core objective now is to save lives, not to preserve physical form."

Lin Ye pointed to the faintly beating vital signs on the monitor:

"The first step is for the vascular surgeon to come in and examine only the main femoral artery and vein, performing precise double ligation for hemostasis;"

"The second step, in orthopedics, involves not cutting bone or suturing muscle flaps; instead, a large amount of hydrogen peroxide is used to rinse away the surface coal ash, and the wound is directly packed with Vaseline gauze and high-pressure dressings for packaging."

"The third step is to immediately transfer the patient to the EICU and use CRRT to correct acidosis and hyperkalemia. After 48 hours, when the internal environment has stabilized, perform a second debridement and closure!"

The deputy director of orthopedics and the chief vascular surgeon exchanged a glance, their anxiety gradually subsiding.

In the face of severe trauma, restraint requires more professional competence than recklessness.

Damage control is the only way for this critically injured patient to survive.

"I agree. I'll contact the anesthesiology department immediately and open an emergency green channel to get him into operating room number nine." The vascular surgery chief on duty nodded.

"Wait a minute! Who's signing this?!"

A middle-aged man in a disheveled suit stumbled in through the nurses' station.

He was the safety manager of the passenger transport company that owned the bus, his forehead covered in cold sweat, clutching the phone in his hand:

"I work for the company... Doctor, how is the driver? How much will the surgery cost? If he dies on the operating table, who will be responsible? His family is still in their rural hometown; they won't arrive by high-speed rail until tomorrow morning at the earliest. I can't possibly sign the consent form for general anesthesia and amputation on his behalf!"

The supervisor was incoherent, so frightened by the dense list of death risks on the critical illness notice that he could barely hold his pen.

"He doesn't need to sign anymore."

A deep, steady voice came from outside the emergency room door.

Liu Zhenhua, deputy director of the medical affairs department, strode in, holding the authorization document for the administrative on-call duty officer, his face cold and stern.

"In cases of major public safety incidents where immediate family members are unable to arrive within the effective treatment timeframe, in accordance with the emergency rescue provisions of the Civil Code and the Medical Practitioners Law, and authorized by the hospital's Medical Quality Management Committee, the on-call administrative officer and the Medical Affairs Department will sign the informed consent form for surgery on their behalf, and the operating room will be opened immediately!"

Liu Zhenhua signed his name neatly, then looked up at Lin Ye: "Lin Ye, prepare for the transfer relay."

"receive!"

However, just when everyone thought the emergency access was clear, the emergency room door was suddenly pushed open.

Fang Rui, who had gone to the blood transfusion department to get blood, rushed back covered in sweat, empty-handed.

"Teacher Lin! Something's happened!"

Fang Rui was panting heavily.

"Among the passengers just brought in, three had massive abdominal bleeding and two had pelvic fractures! The blood transfusion department's stock of suspended red blood cells and plasma was completely used up by the emergency operating room and general surgery!"

Fang Rui pointed to the empty transport box and shouted in despair:

"The blood bank is running low! The entire First Municipal Hospital has less than two units of type O blood left. The blood delivery truck from the central blood bank is completely blocked on the cross-river bridge and can't get through at all!"

"Operating room response... Without at least eight units of blood available, the anesthesiology department refuses to proceed with the procedure!!"

In the emergency room, the monitor's piercing low-pressure alarm suddenly blared.

The driver's blood pressure dropped to 55/35 mmHg again.