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

The echoes of the broadcast still lingered under the ceiling of the emergency room corridor when the automatic sensor door of the resuscitation room suddenly slid open.

"What's going on? Who turned on the secondary broadcast?"

Ma Hao, still clutching two outpatient infusion slips in his hand, strode in from the observation area outside.

He had just finished processing the few patients receiving IV drips when he suddenly heard the emergency room's red zone unusually activate the hospital-wide broadcast button.

As soon as he entered, Ma Hao saw that the second bed in the red zone was surrounded by people.

The three on-call doctors from the obstetrics, general surgery, and intensive care units were all blocked in front of the bed, their faces turning pale and then flushed.

Lin Ye stood beside the stainless steel emergency vehicle, with the milky white biochemical blood collection tube and the test report slapped on the table.

Outside in the passageway, the pregnant woman's husband slumped to the ground, clutching his hair and crying out.

"Doctor! What's wrong with my wife? Why are they making such scary announcements over the loudspeaker?!"

Ma Hao glanced at the atmosphere and immediately understood the current stalemate.

"Lin Ye, I'm leaving this to you."

Without saying much, Ma Hao turned around and stepped outside the sensor door, then pulled the limp family member to their feet.

"Family members, get up and don't block the emergency access! I'm the doctor on duty. Come with me to the consultation room and bring out all her usual cholesterol-lowering medication boxes and pregnancy check-up records. Tell me everything in detail."

The chaos on the outside was instantly cut off and isolated by Ma Hao.

Beside the second bed in the emergency room, the head of the obstetrics department took a deep breath and broke the silence.

"President Lin, this isn't just about whether or not to admit patients; it's about how we simply can't administer the medication."

The on-call obstetrician pointed to the pregnant woman's protruding belly.

"If she were born prematurely at 30 weeks and her pancreatitis worsened, she would have to undergo an emergency cesarean section. According to standard obstetric procedures, we would immediately administer dexamethasone intramuscularly to promote fetal lung maturity. However, she had severe hyperlipidemia. If we administered glucocorticoids, her blood sugar and blood lipids would double instantly, directly pushing her severe pancreatitis towards irreversible necrosis."

"The concerns of general surgery are more direct."

The general surgery on-call doctor turned to the medication page in the patient's medical record.

"In cases of severe acute pancreatitis, high-dose somatostatin must be administered immediately to inhibit pancreatic enzyme secretion. However, somatostatin carries the risk of contraction of uteroplacental blood flow in late pregnancy, and clinical safety data is insufficient. Who can guarantee that the fetus will not experience oxygen deprivation in the womb?"

"The ICU is even more difficult to manage."

A second-line doctor in the intensive care unit pointed to the monitor.

"Triglycerides 28.5 mmol/L, microvascular embolism is spreading."

The standard procedure is emergency double plasma filtration or plasma exchange, but going to the blood bank in the middle of the night to request two or three thousand milliliters of fresh frozen plasma, just the thawing, warming and crossmatching process alone would take at least two hours.

Furthermore, transfusions of foreign blood plasma into pregnant women can easily trigger allergies and transfusion-related lung injury; the fetus simply cannot wait those two hours.

The three specialists laid bare the most authentic weaknesses in their respective fields.

Every concern concerns the lives of both mother and child.

The pregnant woman on the bed groaned in pain, her breathing rapid. The blood gas analyzer beside the bed emitted a long thermal paper: the oxygen partial pressure had dropped to 68 mmHg, and the lactic acid level continued to rise.

Deep in my vision, the countdown timer slowly ticked:

【01:38:40】

【01:38:39】

The gates of systemic inflammatory response syndrome are just one last line of defense away.

Lin Ye opened the drawer of the ambulance and pulled out four blank multidisciplinary joint emergency medical order forms, which he then slapped in front of the three people.

"By the time the plasma is thawed and matched, the patient will have already succumbed to their condition. There are still ways to lower lipids without relying on plasma exchange."

Lin Ye picked up a pen and drew a line directly on the first form.

"Discontinue dexamethasone. Do not start fetal lung-stimulating drugs blindly unless there is a persistent late deceleration in the fetal heart rate. Do not use somatostatin for the time being to avoid placental blood supply risks."

The general surgery and obstetrics on-call staff looked up simultaneously: "Then how do you control fat? How do you suppress pancreatic necrosis?"

"Short-acting insulin is continuously administered via intravenous infusion, with 5% glucose solution for buffering."

The pen tip in Lin Ye's hand scratched softly on the paper.

"Regular insulin is administered via continuous intravenous infusion at a dose of 0.1 units per kilogram of body weight per hour. Insulin effectively activates lipoprotein lipases in peripheral tissues, directly hydrolyzing triglycerides in chylomicrons. It counteracts glucose and lipid imbalances, keeping blood glucose levels firmly between 7 and 10 mmol/L, thus both lowering lipids and preventing hypoglycemia."

The eyes of the second-line ICU doctor suddenly lit up.

"Using lipoprotein lipase as a compensatory hydrolysis method?"

"Not just insulin."

Lin Ye's subordinates continued to issue medical orders.

"Administer 4000 units of low molecular weight heparin calcium subcutaneously. Low molecular weight heparin can promote the release of lipoprotein lipase in capillary endothelium, thus accelerating lipid clearance in two ways. Moreover, large molecular weight substances do not penetrate the placental barrier and will not harm the fetus. Open all fluid access channels, warm Ringer's solution for rapid hydration, and maintain effective circulating blood volume."

Lin Ye put down his pen and turned to look at the head of the obstetrics department.

"The obstetrics department is now introducing portable Doppler fetal heart monitors into the second bed for close monitoring of the fetal heart rate. If the fetal heart rate is stable at 130 to 150 beats per minute, lipid-lowering is carried out at full speed according to the internal medicine plan; if the fetal heart rate drops below 110 beats per minute or a sine wave appears, the obstetrics surgical team will open the package on the spot in the emergency room and perform an emergency cesarean section."

The entire plan is interconnected, precisely avoiding the pitfalls of using fetal lung-stimulating hormone and plasma exchange.

The three duty officers exchanged glances, their previous evasiveness completely gone, replaced by conviction in the face of sound logic.

"This plan can be done."

The second-line ICU doctor was the first to pick up a pen and sign his name in the consultation opinion section of the joint medical order form.

"The ICU will immediately make room for a monitoring bed, equipped with an independent insulin micropump."

"Obstetrics consent."

The obstetrics on-call supervisor also quickly signed off.

"I asked the chief resident to bring the Doppler fetal heart monitor to the second bed. Tonight, I will personally escort it into the intensive care unit and stay by its side."

The general surgery on-call officer also wrote with equal ease.

"General surgeons are on standby at all times. If intestinal perforation or intra-abdominal hypertension occurs, we will respond immediately."

At this moment, Ma Hao pushed open the automatic door and strode back, holding a neatly organized medical record folder in his hand.

"Lin Ye, we've convinced her family. They've signed the informed consent form. This is her medical report from last year. She has a family history of hypertriglyceridemia, but we didn't pay attention to it before she got pregnant."

Ma Hao handed the medical record to Fang Rui and then turned to look at Lin Ye.

"The nurse said the treatment plan has been finalized?"

"It's settled, install the pump."

"Fang Rui, bring the micropump over here!"

Nurse Zhao moved with great speed and efficiency. She mixed 20 ml of short-acting insulin with normal saline, connected the micro-infusion pump tubing, bleed the air, and inserted it into the pump slot.

The needle is inserted, and the fluid is injected into the intravenous access at a constant rate.

Ten minutes later, the Doppler fetal heart monitor was placed on the pregnant woman's high abdomen, and the regular and powerful "thump thump thump thump" sound echoed crisply in the emergency room—the fetal heart rate was 142 beats per minute.

Another twenty minutes passed.

The pregnant woman's intense nausea began to subside, her respiratory rate slowly decreased from 28 breaths per minute to 20 breaths per minute, and the oxygen saturation on the monitor steadily climbed to 97% with oxygen inhalation through a face mask.

In the depths of my vision, the hanging countdown seemed to have been put on its brakes.

【01:02:11】

【01:02:10】

The numbers flashed twice, then silently disappeared.

During the acute outbreak of acute and critical illness, he was forcibly suppressed and killed in the emergency room's red zone.

"The stretcher has arrived; get ready for transfer!"

The head of obstetrics personally held the fetal heart monitor probe, while the ICU transport nurse pushed the monitor. The stretcher rolled across the ground, and under the escort of three doctors, it was steadily pushed into the dedicated elevator passage.

The lead door to the emergency room slowly closed behind us.

The atmosphere, which had been extremely tense, finally relaxed completely.

Fang Rui took off his gloves and felt his back was completely wet. He sat down on the equipment box, panting.

"That was close... I really thought I was going to die in their hands."

Ma Hao leaned against the emergency table, took out a box of green tin candies from his white coat pocket, poured out two candies and threw them into his mouth, then tossed the box to Lin Ye.

"Lin Ye, I just heard you shout 'MDT' on the radio, you were so domineering!"

Ma Hao chewed on a mint and grinned.

"They've completely subdued the two usually arrogant on-call staff in the obstetrics and general surgery departments, so they don't even dare to utter a single word of rebuttal."

Lin Ye caught the candy box, popped out a mint and threw it into his mouth. The cool, stimulating sensation instantly dispelled the heavy weariness in his eyes.

"This plan won't come out until dawn unless we push them to the brink."

Lin Ye handed the candy box back to Ma Hao.

"Alright, the admission form is signed, this hurdle is cleared."

Ma Hao patted the wrinkles on his clothes and was about to walk out.

"I've gone back to the observation area to keep an eye on things. I'm worried Tang Wen won't be able to handle it alone there."

Before he could finish speaking...

The emergency intercom at the nurses' station suddenly rang.

Nurse Zhao grabbed the stethoscope, listened for two seconds, and her expression suddenly turned extremely serious. She looked up at Lin Ye and Ma Hao:

"Lin Ye, Ma Hao, stop talking! A young man in his twenties suddenly experienced severe abdominal pain after playing games with his late-night snack. He collapsed on the steps in front of the triage desk! He's covered in cold sweat, his limbs are ice-cold, and the triage nurse can't feel his radial pulse. She's pushing a stretcher towards the red zone!"