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

The young girl was still breathing heavily when she was wheeled to the bed next to the emergency room.

That breathing was strange.

It wasn't the usual post-run exhaustion, nor was it sobbing from crying.

She inhaled deeply with each breath, her chest heaving violently, as if her body was desperately trying to expel something unseen.

Nurse Zhao brought over the finger-prick blood glucose meter: "Give me your hand."

The girl's companion explained, "Her name is Xu Man, she's 22 years old, and she's been preparing for graduate school entrance exams recently, so she's under a lot of pressure. She was saying she felt palpitations and numbness in her hands in the library just now, and we thought she was hyperventilating."

Sun Zhiqiang asked, "Do you have a history of diabetes?"

His companion shook his head: "No, she's so thin."

Lin Ye squatted down beside the bed: "Xu Man, can you hear me? Have you been particularly thirsty lately?"

The girl nodded with difficulty: "Drink water...keep drinking..."

Do you urinate frequently?

"Hmm... I often wake up at night."

"Does your stomach hurt?"

She slowly pressed her hand against her upper abdomen: "It hurts, I feel nauseous."

Nurse Zhao glanced at the blood glucose meter, and her voice changed.

"Hi, I can't measure the upper limit."

Several people in the emergency room moved at the same time.

Sun Zhiqiang raised his voice: "Intravenous access, draw blood gas, electrolytes, kidney function, blood ketones, and urine ketones. Start fluid replacement first, and notify the endocrinology department."

The girl's companion's face turned pale: "High blood sugar? She really has diabetes?"

Lin Ye didn't give a definitive conclusion: "We now highly suspect diabetic ketoacidosis. Her rapid breathing isn't necessarily due to anxiety; it's her body compensating for the acidosis."

His companion was stunned: "What happens with acidosis?"

Nurse Zhao pushed the treatment cart over: "He might fall into a coma, go into shock, and need to go to the intensive care unit. You're in charge of contacting his family now, not making any diagnoses."

My companion took out his phone, but his hand was shaking so much that he pressed the wrong button several times.

Xu Man suddenly grabbed Lin Ye's sleeve.

"Doctor, am I... going to die?"

Her breath had a faint, sweet smell mixed with the smell of stomach acid.

Lin Ye said in a low voice, "You're in danger right now, but you're not the latest. Don't hold it in; if you feel nauseous, turn your head to the side."

As soon as she finished speaking, Xu Man vomited.

Nurse Zhao reacted quickly, turning her head to one side.

"Prepare for inhalation, avoid accidental inhalation."

The blood and energy returned quickly.

pH 7.08.

The bicarbonate level was significantly low.

Potassium 5.7.

The urine ketone test was strongly positive.

Sun Zhiqiang frowned as he looked at the results: "It's extremely acidic. Infuse fluids, closely monitor blood potassium levels, use an insulin pump and other potassium supplementation strategies, and follow endocrine recommendations. Don't push anything haphazardly."

Lin Ye nodded.

The system only displays the risks, but does not provide treatment details.

Every step must be taken more steadily.

If you don't understand, don't pretend to understand; if you can ask someone for help, ask them for help immediately.

When Han Qing arrived, her hair was neatly tied up, and she was holding a half-finished cup of coffee.

She glanced at the blood gas and electrolyte levels, and her first words were, "Don't treat this as ordinary high blood sugar. It's diabetic ketoacidosis. It requires fluid replacement, insulin, potassium monitoring, and close monitoring of urine output. Her potassium level is high now, but that doesn't mean her body isn't deficient in potassium."

Sun Zhiqiang handed over the treatment records: "It has been treated according to the diabetic ketoacidosis pathway."

Han Qing looked at Lin Ye: "Who came up with that idea first?"

Lin Ye pointed to the blood glucose meter next to the emergency bed: "Deep and rapid breathing, excessive thirst, abdominal pain, blood glucose HI."

Han Qing put the blood gas report back on the treatment cart: "This is more reliable than 'anxiety attack'."

Xu Man's companion blushed deeply: "I didn't mean to, she used to get so nervous she couldn't breathe..."

Han Qing didn't scold her, but only said, "Anxiety is really uncomfortable, but the emergency room can't treat every young girl's shortness of breath as anxiety. Especially with her breathing, her body is trying to save itself."

He turned to look at the high-risk list on the wall.

"For a young woman experiencing palpitations, rapid breathing, and numbness in her hands, do not immediately classify her as an anxiety patient. First, check her blood sugar, blood gas, oxygen saturation, and vital signs."

Nurse Zhao picked up a red pen: "You tell me, I'll write it down."

She added one item at the bottom of the list.

[Anxiety-induced shortness of breath: First rule out hypoxia, hypoglycemia/hyperglycemia, acidosis, and arrhythmia, then discuss emotions.]

After reading it, Sun Zhiqiang muttered, "I like this one from the nurses' station."

Han Qing glanced at him: "You should see a doctor too."

When Xu Man's mother arrived, she was crying so hard she could barely stand.

"How could my daughter have diabetes? She's not fat, and she even diets regularly."

Han Qing helped her to the side: "Diabetes isn't just about weight. We need to treat the acute acidosis first; we'll talk about the subtype and long-term treatment later."

The mother grabbed Lin Ye anxiously: "Doctor, will she suffer any long-term effects?"

Lin Ye slowed his tone: "The most important thing now is to correct the acidosis and prevent her from losing consciousness and going into shock. She's still conscious, which is a good thing. We've already consulted an endocrinologist, and treatment is underway."

Xu Man lay on the bed, her breathing still deep, but her eyes were a little more focused than when she first came in.

"Mom... I wasn't faking it."

Tears welled up in her mother's eyes: "Who said you were faking it? Mom just thought you were too tired."

The companion next to him lowered her head and cried, "I'm sorry, I thought so too..."

While adjusting the IV drip, Nurse Zhao said in a low voice, "The worst thing in the emergency room is 'assuming'."

The system prompts an error.

[Patients in the red zone: Entering effective treatment procedures.]

[Current night shift: Night 3.]

[In-hospital deaths: 0.]

[Emergency Room Weekly Progress (Zero Fatalities): 3/7, Pending Confirmation]

Lin Ye watched as Xu Man was connected to the endocrine therapy pathway, his pen still in his hand.

On the third night, the same spot was hit twice in a row.

High potassium levels look like an upset stomach.

It looks like anxiety-induced acidosis.

Each new item on the list represents someone who almost got missed.

At four o'clock in the morning, He Jianye returned the phone call from the dialysis room.

"Zhao Guobin's potassium level has dropped and he's stable for now. Could you send me a photo of that list from the emergency room? I'll post it on the dialysis room door."

Han Qing added, "Send me this diabetic ketoacidosis report, and I'll have the endocrinology clinic nurse take a look at it too."

Nurse Zhao listened to both phone calls and looked up at Lin Ye.

"Your list is practically becoming a cheat sheet for the whole college."

Sun Zhiqiang capped his pen: "A cheat sheet is good. When the exam actually comes, it'll be good if someone can copy it correctly."

At six o'clock in the morning, Xu Man was transferred to the endocrinology ward for continued treatment.

When she passed the nurses' station, her breathing wasn't so bad anymore.

The mother, supporting herself on the bedside, repeatedly thanked Lin Ye.

Lin Ye only said, "Listen to Director Han from now on, don't stop taking the medicine on your own, and don't be scared by online remedies."

The mother nodded: "Yes, I will listen."

The list on the wall was somewhat messy due to red pen corrections.

Qin Hai stood by and watched for a while, then suddenly said, "Don't write it by hand today, rewrite it into a new version."

Lin Ye smiled bitterly: "Again?"

Qin Hai looked at him: "You think the process is finished once it's written? The process is typed out by the night shift."

No sooner had he said this than Liu Zhenhua appeared at the entrance of the corridor with people from the dean's office.

He looked at the sheet of paper covered in writing on the wall, and his first words were:

"The dean wants to see this list of yours."

Nurse Zhao nearly dropped the pen in her hand.

Sun Zhiqiang immediately looked at Lin Ye: "You're finished."

Lin Ye also looked at the paper.

There were red pen marks, tape marks, and light stains from medicine on the paper.

It doesn't look like an official document at all.

This is just like the most realistic picture of the emergency room this week.

Liu Zhenhua said, "There will be a short meeting at 10 a.m. Don't be nervous, it's not a disciplinary action."

Qin Hai sneered: "Every time you say it's not a punishment, I get nervous."

Liu Zhenhua did not refute.

He simply held up his phone and took a picture of the list.

"This might be a promotion."