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

Emergency room at Cangshan County Hospital.

"Lin Ye? Are you at Cangshan County Hospital?"

"Do you even know what you're saying? Drilling a hole next to the bed? There's no emergency CT scan in the entire hospital, no neurosurgeon. Who gave you the audacity to operate on the skull?"

"If the drill bit deviates by two millimeters and damages the middle meningeal artery, or tears the skin, the person will die instantly!"

Luo Jianping's questions came crashing down on him.

Lin Ye stared intently at the old farmer on the emergency bed.

The elderly man had a swollen hematoma on his right temple and was snoring loudly.

Once the compression of the brain by a herniated brain exceeds the critical point, any rescue efforts will be meaningless.

"Director Luo, the injured man is 52 years old. He fell into the ditch and sustained pressure on his right temporal region. He is in a typical state of lucidity during the intermediate phase!"

"He fell into a coma two hours after the injury. His right pupil was dilated to 4.5 mm with no light reflex, and his left Babinski sign was positive!"

"Accompanied by Cushing's reflex, heart rate of 42, blood pressure of 185/110, a classic late-stage temporal lobe uncus herniation!"

"A bony step-like sensation can be felt upon palpation of the right temporal region; a squamous fracture of the temporal bone is palpable!"

"The CT technician from Cangshan is still on his way. It will take an hour and a half to transfer him back to the First Municipal Hospital tonight. The injured will definitely not survive until they leave the county!"

There was a deathly silence on the other end of the phone.

Based solely on these physical signs, Luo Jianping knew that the patient's intracranial pressure was on the verge of collapse.

Who was there?

Luo Jianping's voice turned serious, revealing only his rigorous and decisive nature.

"The entire medical team from the First Municipal Hospital was present."

"Zhao Feng, a senior attending physician in general surgery, is in charge of the equipment; Liang Shumin, deputy director of obstetrics and gynecology, is in charge of the airway and mannitol dehydration; and nurses from Cangshan are assisting."

"We have autoclaved cranial drill kits, bone forceps, and bipolar electrocoagulation equipment."

"I requested remote guidance from neurosurgeon, with Dr. Zhao Feng as the lead surgeon and me as the first assistant, for bedside single-port bone window decompression."

Zhao Feng stood beside the equipment table and spoke loudly into the speakerphone:

"Director Luo, this is Zhao Feng from general surgery! The equipment has been verified!"

The receiver emitted a notification tone indicating that the landline recording had been activated.

"Turn the hands-free volume to maximum. This is a remote emergency guidance session, and the entire process will be recorded."

"Lin Ye, what are the anatomical landmarks?"

Lin Ye answered immediately.

"Using the pterion as the center, make a 3-centimeter straight incision vertically downwards, two finger-widths above the midpoint of the zygomatic arch and 3.5 centimeters above and in front of the external auditory meatus, avoiding the comminuted bone fragments!"

"Directly above the groove of the anterior branch of the middle meningeal artery!"

"Accurate positioning."

Luo Jianping gave the order decisively.

"Liang Shumin, administer two bags of mannitol via pressurized intravenous drip, and ten milligrams of dexamethasone via intravenous push. Monitor her respiration and heart rate."

"Zhao Feng, inject lidocaine and adrenaline into the scalp for infiltration, cut open the skin, use a periosteal elevator to push open the periosteum and expose the bone."

"clear!"

Liang Shumin squeezed the mannitol pouch, and the medication was injected into the vein through the thick needle.

Zhao Feng gripped the scalpel and deftly made a cut along the marked line on the temporal region.

Fresh blood seeped out, and Lin Ye used a suction device to clean the surgical field, then used two hemostatic forceps to clamp the aponeurosis and compress it to stop the bleeding.

The periosteal elevator was pushed into the incision, and a hard, crisp peeling sound rang out.

A two-centimeter square section of the squamous part of the temporal bone was exposed, and a dark, fine transverse fracture suture was clearly visible.

"The fracture line matches the prediction!"

Lin Ye reports.

Luo Jianping shouted in a deep voice.

"Get a hand drill! Install the depth limit ring and adjust the depth to five millimeters!"

"Zhao Feng, apply pressure perpendicular to the bone surfaces with both hands and rotate at a uniform speed!"

"The skull has three layers: the outer plate is hard and has great resistance. When it enters the diploic area, dark bone fragments will overflow and the resistance will decrease. When it touches the inner plate, the resistance becomes hard again. At this point, immediately reduce the downward pressure by 80% and slowly grind it with cutting force."

"If you feel a sense of emptiness, you must lift the drill bit within 0.1 seconds!"

Zhao Feng took the hand-cranked skull drill and placed the blunt-tipped drill bit with a limiting collar against the bone surface.

Lin Ye picked up the sterile syringe and aimed the needle at the cutting point.

"start!"

Zhao Feng exerted force with his wrist and cranked the handle!

"Crunch... crunch..."

The dull sound of bone being cut suddenly rang out in the emergency room!

White bone meal was exposed, and Lin Ye quickly injected ice-salt water to rinse and cool it down.

【00:06:15】

Only six minutes left in the countdown.

"We've entered the barrier."

Zhao Feng snorted softly.

Bone fragments were mixed with dark brown blood droplets, and the resistance noticeably softened.

"Slow down! Release the downforce."

A stern reminder came through the speakerphone from Luo Jianping.

"Prepare to attack the inside plate."

Zhao Feng held his breath, and the hand drill suddenly slowed down.

Two laps, three laps...

The handle became stiff again as it turned, hitting the hard inner plate.

The heart rate on the monitor dropped to forty beats per minute.

Zhao Feng was completely focused, sweat beading on his forehead. Lin Ye gently wiped it away with gauze and steadily held the flushing tube.

"Snap!"

A very faint, crisp sound traveled from the drill shank to the palm of the hand.

The resistance from his subordinates vanished suddenly!

Zhao Feng's pupils contracted, and his arm muscles instinctively pulled upwards, instantly disengaging the hand drill from the bone hole!

The retaining ring is firmly stuck on the bone surface.

An eight-millimeter circular bone hole was revealed.

There was no normal brain tissue deep inside the hole, only a dark purplish-black area!

Those were the dura mater, crushed flat, and blackish-red blood clots, solidified like jelly, attached to the edges of the bone plates.

"It's through! Dark purple blood clots are visible!"

Lin Ye reports.

"Use bone forceps to bite open the thin inner bone and enlarge the bone window to one and a half centimeters!"

Luo Jianping shouted into the phone.

Zhao Feng switched to bone-biting forceps, his movements extremely steady, biting off the hard bone spurs along the bone edge.

With the bone window enlarged, Lin Ye replaced it with a flat meningodemagogist and gently lifted it along the inner side of the inner plate.

"puff!"

A very faint breaking sound rang out.

High-pressure blood clots and blood clots accumulated between the bone plate and the dura mater surged violently out along the edge of the bone window.

Dark red, viscous blood mixed with clots splattered onto the drape, instantly filling the air with the stench of blood.

Lin Ye quickly sucked out the accumulated blood, and Zhao Feng used a gelatin sponge soaked in ice-cold saline to compress the bone edge.

The gushing blood amounted to a full thirty milliliters!

After the decompression, the previously pale, taut, and pulsating dura mater suddenly trembled slightly.

Then, a gentle and rhythmic up-and-down pulsation reappeared.

"The dura mater is pulsating again!" Zhao Feng shouted.

The piercing alarm on the monitor stopped abruptly.

The heart rate, which was originally 40 beats per minute, quickly rebounded:

Forty-eight...fifty-six...sixty-five...seventy-two!

Blood pressure steadily dropped to 135-185 mmHg!

Liang Shumin let out a long breath: "Airway resistance has decreased, and spontaneous breathing has resumed."

Lin Ye immediately picked up a spotlight and shone it on the wounded man's right eye.

The dilated pupils, which had originally expanded to 4.5 millimeters, quickly closed and contracted under bright light, shrinking steadily back to 2.5 millimeters.

It recovers sensitively to light reflection.

Before Lin Ye's eyes, the pale blue countdown timer, hovering around the two-minute mark, flickered briefly before disappearing completely.

"The right pupil has constricted to 2.5, both pupils are equal in size, and the light reflex has returned."

On the other end of the phone, Luo Jianping let out a long sigh of relief.

"They've been saved."

"Zhao Feng, the bleeding has been completely stopped. A negative pressure drainage tube has been placed, and the aponeurosis and skin have been tightly sutured."

"Lin Ye, well done. But this is just bedside decompression, temporarily relieving the brain herniation crisis."

"The patient must remain supine with their head turned to the unaffected side, and the drainage bag must not be higher than the level of the tragus!"

"Once the CT room is turned on, immediately perform a thin-section CT scan to rule out delayed hemorrhage."

"Understood! Thank you, Director Luo!" Lin Ye and Zhao Feng responded simultaneously.

Zhao Feng changed his suture needles and skillfully performed full-thickness tension-reducing sutures on the wounded soldier's scalp.

Dark red residual blood is dripping from the drainage tube.

Just as Zhao Feng tied the last knot and cut the thread!

"Bang!!"

The spring-loaded door to the emergency room was flung open with tremendous force!

A middle-aged man in a white coat stumbled in, sweating profusely, his chest heaving, and gasping for breath.

"Manager Lin! Manager Lin is on duty!"

"The high-pressure preheating is complete! Director Guo called my home phone and started cursing!"

"Where is the patient? Bring him over quickly and get him scanned! Any more delay and he'll suffocate..."

The CT technician's voice suddenly caught in his throat halfway through his call.

His bloodshot eyes were fixed on the resuscitation bed.

The old farmer had a bandage wrapped around the right side of his scalp, and a drainage tube hung beside the bed, with dark red blood slowly dripping down.

The bedside monitor showed a heart rate of 72, blood pressure of 130-180, and stable breathing.

On the instrument table next to it, there were hand-cranked skull drills and bone-biting forceps stained with mottled dark red blood.

The serious voice of Luo Jianping, director of neurosurgery at the First Municipal Hospital, could still be heard through the hands-free speakerphone of the red emergency hotline.

"After the follow-up CT scan, the original images were directly transmitted to the consultation system of the First Municipal Hospital."

The CT technician stood frozen at the door, his mouth agape, wide enough to fit an egg.