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

The old farmer stumbled along beside the flatbed cart, his hands covered in black mud, tears streaming down his face.

"Doctor, please save my child! He's only twenty-two...please!"

"Fellow villager, wait outside, don't block the emergency access!"

The emergency room nurses quickly stopped the elderly farmer outside the gate.

Lin Ye followed inside the flatbed wagon's guardrail, his body weight resting on his right hand.

The heel of his right hand was pressed firmly against the pulsating point below the groin ligament of the wounded man, his dark sleeve soaked with warm blood, suppressing the ruptured femoral artery below.

"Make way! One bed in the emergency room!"

Guo Shusen followed quickly behind, holding a half-finished transfer form in his hand, his forehead covered in sweat.

"Captain Lin, the belt pulley is entangled, the skin and flesh are turned outwards, even the edge of the femoral head is exposed, and the aorta is severed in two. Our county hospital doesn't have a vascular surgery department, and the supplies are incomplete. It's better to get him directly to the ambulance than to delay in the emergency room..."

"Why put him in an ambulance!" Zhao Feng interrupted in a deep voice, carrying his portable surgical kit. "It's an hour and a half each way on this winding mountain road. The patient's systolic blood pressure is undetectable. He'll suffer cardiac arrest before the car can travel five kilometers!"

The flatbed cart smashed open the spring door and rushed into the emergency room.

"Change the bed! One, two, three, lift!"

Lin Ye and Zhao Feng worked together seamlessly to move the wounded.

The injured man's conjunctiva was deathly pale, his pupils had sluggish light reflexes, his extremities were cold and clammy with mottled patches, and his breathing was shallow and rapid, like a sigh. He was on the verge of severe hemorrhagic shock.

At the edge of the forest's field of vision, extremely faint, ghostly blue countdown numbers were ticking:

【00:11:08】

"The defibrillator is powered on and ready for use!"

Lin Ye quickly connected the power cord and pressed the self-test button.

The instrument emits a short self-test beep, and the green light illuminates.

"Director Liang, check the airway and circulatory monitoring! Nurse, establish bilateral venous access and begin full-speed fluid resuscitation!"

Liang Shumin quickly put on the mask and administered high-flow oxygen, efficiently cleared the oral secretions, and then attached the monitoring electrodes to her chest.

Two nurses on duty at the county hospital pushed the treatment cart forward. One of them tightened the arm compression strap, while the other used an 18G thick cannula to puncture the left elbow fossa.

However, when the needle tip was inserted subcutaneously, there was no blood return at the end of the cannula.

"No! The systolic blood pressure is too low; the peripheral vein walls have completely collapsed into a rubber band, there's no blood return, and we can't insert the catheter at all!"

"Try the expensive intravenous method again!"

Another nurse said urgently.

"Don't try it."

Liang Shumin reached out and pressed her hand on the wounded man's carotid artery, her expression serious.

"In stage IV hemorrhagic shock, the microcirculation is shut down, and the superficial veins are completely spasmed and collapsed, making it impossible to insert a puncture via a conventional access route."

Standing at the foot of the bed, Guo Shusen hurriedly offered a suggestion: "Then let's do a deep vein puncture! Insert a central venous catheter below the clavicle!"

"Too late."

Lin Ye lowered his head and interrupted the suggestion directly.

"In the emergency room, there is no bedside ultrasound guidance. Blindly inserting a puncture under the clavicle would require at least ten minutes of draping and positioning. The patient was breathing shallowly and was agitated. Blindly inserting a puncture could easily damage the pleura, causing pneumothorax or hemothorax. He wouldn't last three minutes."

In a state of extreme shock, time equals blood volume.

"Bring me my first aid kit!"

Lin Ye maintained a firm downward pressure with the heel of his right hand, while his left hand opened the side pocket of his canvas bag and took out a set of silver-gray, wide-caliber bone marrow puncture devices.

Guo Shusen was taken aback: "Bone marrow aspiration? Adult bones are so hard, how can you inject water into them?"

"The medullary cavity is densely covered with cavernous venous sinuses, which are rigidly supported by the hard bone cortex. No matter how severe the shock, the walls of the venous sinuses will never collapse. Once the bone cortex is penetrated, a ready-made central venous access is established."

Lin Ye quickly slid his left thumb to locate the tibial tuberosity: then moved down two finger widths and inward one finger width to touch the flat, smooth inner surface of the tibia.

Iodine-soaked cotton balls quickly disinfect the affected area.

Lin Ye firmly gripped the puncture needle handle, keeping the needle tip perpendicular to the bone surface at a 90-degree angle.

With continued downward pressure applied to the wrist, accompanied by a dull tremor from the bone drill, the hard cortical bone responded with a distinct feeling of emptiness and breakthrough.

Remove the needle core, connect the syringe, and quickly aspirate.

With a soft "poof," a tube of dark red, thick bone marrow blood flowed smoothly into the tube!

"It's open! The medullary canal access has been established!"

"Pressure bag, pump in 2000 ml of balanced salt at full speed! Attach two bags of type O red blood cells directly, manually pressurize and rapidly inject, crossmatching proceeds simultaneously!"

The nurse quickly connected the special tubing, attached an inflatable pressure bag, and filled the bag to 300 mmHg. The pressurized balanced salt was then flushed into the tibial medullary cavity through the tubing.

Rigidly supported venous sinuses rapidly direct fluid into the deep venous network.

In less than two minutes, the first bag of liquid was rapidly pumped into the body's circulation.

Finally, vital signs were detected on the bedside monitor:

Heart rate: 154 beats/min;

Blood pressure: 48/28 mmHg.

"The blood pressure has stopped dropping." Liang Shumin stared intently at the monitor screen. "The carotid pulse has become slightly stronger, and the pupillary light reflex has improved slightly."

"Move the tourniquet upwards and replace manual compression."

Lin Ye looked at Zhao Feng beside him.

Zhao Feng changed into sterile gloves, took out a screw-on tourniquet, and smoothly slipped it onto the injured man's right thigh, pushing it down to two finger widths below the inguinal ligament. He then tightened the metal knob clockwise.

As the tourniquet fully tightened, Lin Ye slowly withdrew his aching right palm.

The high-pressure gushing from the wound was stopped, leaving only a deep, dark red oozing of blood.

However, high tourniquet compression is only a temporary measure, as the proximal thigh has a limited tolerance for ischemia, and vascular reconstruction must be completed as soon as possible.

"Take him to the operating room, Dr. Zhao. The exploration and vascular anastomosis are up to you."

"Don't worry, leave it to me."

Zhao Feng led the way, carrying the equipment case.

The stretcher was quickly transferred to the emergency operating room.

The shadowless lamp was moved directly above the surgical field.

The wound on the right thigh of the injured soldier was torn inward from the root of the thigh for 20 centimeters, reaching the muscle layer. The subcutaneous tissue was severely contused, and the straw, grass clippings and mud that were rolled in by the farm machinery were deeply embedded between the muscle fibers.

Zhao Feng repeatedly rinsed the wound with a large volume of saline solution to clean the surface dirt.

As his deeper vision came into view, Zhao Feng's expression suddenly turned serious.

"The proximal stump retracted violently into the deep pelvic floor, making it impossible to reach with conventional hemostats. The distal contusion and defect was a full five centimeters long, with extensive abrasion and tearing of the vessel wall and inner lining, making direct end-to-end anastomosis impossible."

If the two ends are forcibly pulled together and sutured, the enormous tension will inevitably lead to anastomotic tearing or secondary thrombosis.

Guo Shusen stood in the audience, circling around: "Captain Lin, Dr. Zhao, the county hospital has no artificial blood vessel in stock. Even if the proximal end is clamped, without a substitute blood vessel, the chances of saving the limb are extremely slim. Once the limb necroses, it can also lead to rhabdomyolysis and acute renal failure..."

"Artificial blood vessels cannot be used. These kinds of agricultural machinery entanglement injuries are heavily contaminated wounds, and the infection rate of artificial grafts is extremely high. Once infected, they can cause fatal massive bleeding."

Zhao Feng lowered his head, staring intently at the depths of the wound.

"Autologous blood vessels must be used."

The countdown at the edge of the forest's field of vision moved silently:

【00:06:21】

The injured person's blood pressure was maintained at 54/34 mmHg under pressure and fluid resuscitation.

Lin Ye put on sterile gloves, inserted his fingers into the deep layers of the wound, and with his precise anatomical sense, his fingertips firmly pressed against the deep, spasming, throbbing proximal arterial nodule.

"Dr. Zhao, insert the Satinsky non-traumatic lateral wall blocking forceps two centimeters in the direction of my fingertips."

Lin Ye kept his finger hovering in place, clearing a path for Zhao Feng.

Zhao Feng slid the clamps along Lin Ye's fingertips into the deeper layers, firmly clamping the proximal femoral artery.

"Proximal occlusion successful, the field of vision is clear." Zhao Feng breathed a sigh of relief, then looked at the wound defect, "But where do we get the missing five centimeters of autologous blood vessel?"

Lin Ye shifted his gaze to the injured man's healthy lower limb.

"Take the great saphenous vein from the left leg. The diameter is similar on the healthy side, and autologous transplantation has the strongest resistance to infection, and it will not damage the remaining collateral blood flow in the injured right leg."

Zhao Feng's eyes lit up: "Great decision! I'll take the blood vessel and anastomose it with the surgeon. You can go up as an assistant to help expose the field of vision."

Zhao Feng took the scalpel and prepared to make an incision in the healthy thigh to collect a blood vessel.

Just as the scalpel tip touched the skin, the anesthesia monitor next to the table suddenly emitted a sharp low-pressure alarm!

The electrocardiogram waveform accelerated drastically, and the previously stable blood pressure suddenly dropped to 38/20 mmHg!

"Zhao Feng, Lin Ye! The wounded soldier's lower abdomen is rapidly swelling and tightening, the abdominal wall is as hard as a board, and his blood pressure has plummeted!"

Liang Shumin, who was standing guard by her head, suddenly lifted the surgical slip, her tone changing abruptly.