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

At 1:35 a.m., the first thing to arrive at the emergency room entrance was not an ambulance.

It has a sour, foul smell.

The night wind, carrying vomit, sweat, and the musty smell of the bus that had been inside all the way, rushed into the emergency room.

Nurse Zhao had just finished filing the hyperbaric oxygen transport record when she looked up and frowned.

"This tastes wrong."

Outside the gate, the first ambulance came to a stop.

The car door opened, and an elderly man was carried out.

The old man was extremely thin, with chapped lips, sunken eyes, and the skin on the back of his hand wouldn't spring back even after being pinched for a long time.

A tour guide followed behind the flatbed cart; his face was as white as paper.

"Doctor, more than a dozen people on the bus vomited and had diarrhea. The service area didn't dare to let us stay, saying the elderly person was not doing well, so they told us to come to the hospital immediately."

Qin Hai came out of the emergency room, his hands, which he had just washed, were not yet completely dry.

How many people?

The tour guide's lips trembled.

"Of the twenty-seven tourists, more than a dozen have vomited. Two elderly people can't stand up, and a child keeps vomiting."

Nurse Zhao's face darkened.

"Triage should not be crowded together."

Qin Hai raised his hand.

"Activate the crowd control measures. Those who can walk should sit in the observation area, while the elderly, children, those with low consciousness, and those with low blood pressure should go to the emergency area first. Everyone should wear masks, and vomit should be sealed in bags and not dumped in the lobby."

The tour guide panicked.

"You probably just got an upset stomach. We ate boxed meals at the service area last night."

Qin Hai looked at him.

"Eating bad food can kill you."

This sentence froze the tour guide in place.

The first elderly person was wheeled into the emergency room.

Lin Ye stood by the bed.

The old woman's name is Yuan Guilan, and she is seventy-eight years old.

The tour guide said she started having diarrhea at 10 p.m. and vomited three or four times. She kept saying she was thirsty on the way.

The monitor popped up with numbers as soon as it was clipped on.

Blood pressure is 82.50.

Heart rate 128.

Body temperature 37.8 degrees Celsius.

Oxygen saturation is 96%.

Nurse Zhao touched the back of the old man's hand and frowned.

"The blood vessels are severely collapsed."

The old man had his eyes open, but he didn't have much strength.

He kept mumbling, "Water...water..."

The middle-aged woman accompanying them was extremely anxious.

"Doctor, please give her some water; she's been thirsty all the way here."

Lin Ye reached out to stop him.

"Don't force-feed her now. Her blood pressure is low, she's vomited, and she's not fully conscious, so she's likely to choke."

The woman's eyes reddened.

"What should we do then?"

Qin Hai has already reviewed the guardianship.

"Establish intravenous access first, and begin fluid resuscitation. Draw blood for electrolytes, kidney function, blood glucose, complete blood count, infection markers, blood gas analysis, and lactate levels. Collect a stool sample. Find out what the person ate and who developed symptoms first."

Nurse Zhao gave the injection while reporting the news.

"For elderly people with dehydration and low blood pressure, first check the red zone."

The tour guide was still making a phone call at the entrance.

"Don't get out of the car and wander around. Wait for the doctor's instructions... It's not that you can't use the restroom, it's just that you need to register first!"

Before he could finish speaking, the second ambulance arrived.

This time, it was a boy who came down.

When she was seven or eight years old, she was held in her father's arms.

The child's face was ashen, his eyes were half-closed, and his limbs were limp and hanging down.

The father ran and shouted.

"Doctor! He vomited six or seven times, and we couldn't wake him up!"

Nurse Zhao immediately looked up.

"The child is over here!"

Just as Lin Ye was about to go over, the system notification lit up.

[Final-stage high-risk screening initiated.]

[Outbreak of diarrhea: Risk of dehydration and shock in the elderly.]

[Risks for children: Hypoglycemia/electrolyte imbalance/severe dehydration.]

[Note: High-risk individuals from different sources may be mixed in with individuals involved in group incidents.]

The last line made him walk even faster.

The child was placed on another emergency bed.

Nurse Zhao is testing blood sugar.

"3.1"

Not extremely low.

But for a child who is vomiting repeatedly and is in poor spirits, it is dangerous enough.

Heart rate 140.

Blood pressure: 88-56.

Dry lips, few tears.

The abdomen is soft, and the patient frowns when pressed.

Lin Ye asked his father, "Does he have a fever? How many times has he had diarrhea? Is there any blood in his stool?"

My father was breathing heavily.

"He had diarrhea three times, all watery. I didn't see any blood. We ate a boxed meal at the service area that night: chicken leg, cold dishes, and soup. His mother also vomited; she's still in the car."

Qin Hai looked up when he heard "cold dishes".

"List everyone who ate cold dishes separately. List those who developed symptoms even though they didn't eat cold dishes as well."

The tour guide peeked out from outside the door.

Why?

Qin Hai didn't have time to explain much.

"Find the source, but also find people who are not from the same source."

Sun Zhiqiang ran back from the observation area.

"Director, eleven people can walk now, three are vomiting badly, two elderly people can't sit still, and a young man says he feels tightness in his chest, but he refuses to lie down, saying he just gets carsick."

Qin Hai's expression changed instantly.

"If you feel tightness in your chest, poop it out first."

Sun Zhiqiang was stunned for a moment.

"He threw up too."

"You can have a heart attack even if you vomit."

This sentence was like a stone that had rolled out from many nights before, silencing everyone.

Lin Ye looked towards the observation area.

A man in his thirties sat on a plastic chair, his face pale, his hand clutching his upper abdomen.

Everyone around him was grabbing vomit bags, but he didn't vomit.

I was just sweating constantly.

The system interface in front of Lin Ye did not directly provide a name for the disease.

The gray cursor blinked twice.

[Non-homologous high-risk screening in progress.]

Lin Ye walked over.

Where do you feel unwell?

The man frowned.

"My stomach is aching, and my chest feels tight. The car smells terrible, and I get carsick."

"When will it start?"

"Half an hour ago."

"Do you have diarrhea?"

The man paused for a moment.

"no."

Lin Ye immediately turned his head.

Electrocardiogram (ECG)

The man became irritable.

"I really don't have a heart condition, I'm only thirty-six."

Nurse Zhao pushed the electrocardiogram machine over and casually added a comment.

"Emergency rooms treat patients without checking their ID cards."

Before the man could say anything more, the electrode pads were already attached to his chest.

Paper is ejected from the machine.

Lin Ye glanced down and felt a chill run down his spine.

The ST segment depression in the inferior leads was not obvious, but there were signs of dynamic changes.

Not typical enough.

But you absolutely cannot throw them back into the "food poisoning" pile.

Qin Hai took the electrocardiogram.

"Draw troponin, repeat ECG, and put the patient on monitoring. Ask if they have high blood pressure, diabetes, or smoke."

The man's expression changed.

"I'm just on a tour, why do I need a heart check?"

Qin Hai placed the electrocardiogram in front of him.

"Because you don't have diarrhea, but you say you have chest tightness, upper abdominal pain, and sweating."

The man fell silent.

Someone shouted again from the observation area.

"Doctor, this old lady can't stand up!"

The second elderly man was being supported by two tourists; his legs were so weak they seemed to have no bones.

Lin Ye only glanced at it before sensing something was wrong.

She is not simply a hypocrite.

Her eyes were vacant, her lips were dry, and her breathing was shallow and rapid.

Nurse Zhao helped the person into a wheelchair.

Blood pressure is 78 or 48.

Heart rate 132.

My hands and feet are cold.

Qin Hai gave the order directly.

"The second elderly person has also been admitted to the red zone. Two intravenous lines have been established for fluid resuscitation and monitoring. Urine output is being recorded."

The tour guide was almost in tears.

"We're just here on vacation, how could this happen?"

Liu Zhenhua arrived just in time to hear this.

He held the notebook he hadn't put down since the factory incident, and turned to a new page.

"Write down the tour group list, seating chart, what everyone ate tonight, who vomited first, who had diarrhea first, and who had no symptoms."

The tour guide was completely stunned.

"Write now?"

Liu Zhenhua handed over the pen.

"Write it now. Tomorrow, all you'll remember is everyone shouting it."

The emergency observation area was temporarily divided into three sections.

Those who can walk and have stable blood pressure should sit to one side.

Elderly people and children enter the red zone.

Men experiencing chest tightness and upper abdominal pain should be placed under separate monitoring.

Tour guides and drivers were forced to fill out the names on the triage desk.

Nurse Zhao wrote on the whiteboard with a marker:

Total number of passengers on the bus: 27.

Illness has occurred: tentatively recorded as 13.

Red Zone: 2 elderly people, 1 child.

Sole monitoring: Chest tightness and upper abdominal pain 1.

Further investigation needed: The remaining cases involved vomiting and diarrhea.

After she finished writing, she muttered a curse under her breath.

"You really know how to pick your timing tonight."

Lin Ye didn't reply.

He was observing Yuan Guilan's blood and qi.

Lactic acid levels are elevated.

Blood potassium levels are low.

Creatinine levels are also high.

The dehydration had progressed to the point of affecting circulation and kidney function.

After reading it, Qin Hai's expression darkened even more.

"This can't be just considered gastroenteritis. It's early-stage hypovolemic shock, so keep a close eye on the rehydration response. Notify the gastroenterology and infectious disease departments; both the elderly and children need to be seen."

Sun Zhiqiang handed over the children's lab results.

"The child also has low potassium, borderline low blood sugar, and poor mental state."

Qin Hai nodded.

"Pediatrics is also called that."

Lin Ye picked up the phone.

First, treat the pediatrics department.

When Liang Xiulan answered the phone, her voice was already simmering with anger.

"Lin Ye, what time is it?"

Lin Ye glanced at the clock on the wall.

"1:53. A group of buses at the highway service area experienced vomiting and diarrhea. One child was vomiting repeatedly, was lethargic, had low blood pressure, blood sugar of 3.1, and low potassium."

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

"I'm coming down."

The second call was made to the infectious disease department.

After listening, Xu Mingzhe only asked one question.

"How many people?"

"Thirteen cases have been reported so far, with twenty-seven people traveling in the same vehicle. The source of infection is unknown, and two elderly people have low blood pressure."

"Take a sample, isolate the vomit and excrement first, and find out if there is fever, bloody stool, or if they have eaten together. Don't let people crowd together. I'm coming."

The third call was to the gastroenterology department.

Upon hearing "two elderly people with low blood pressure," the on-duty doctor was no longer sleepy.

"immediately."

The group chat for the directors lit up quickly.

Liang Xiulan: [Another bus?]

Xu Mingzhe: [The bus group is experiencing diarrhea; the infectious disease department is dispatched.]

Tang Zhendong: [Don't call me this time.]

Qin Hai picked up his phone and sent a message.

[You're under separate monitoring due to chest tightness and upper abdominal pain. You'd better not sleep too soundly.]

Tang Zhendong: [...]

Nurse Zhao glanced at her phone.

"Director Tang is getting more and more adept at using ellipses."

Nobody has time to laugh.

The man's second electrocardiogram (ECG) came out because of chest tightness.

Lin Ye took the paper, his heart sinking.

The changes are more obvious than in the first picture.

Troponin hasn't returned yet.

But this person can no longer sit in the observation area.

After reading it, Qin Hai picked up the phone immediately.

"Urgent cardiology consultation. The bus group's vomiting and diarrhea were mixed with chest tightness and upper abdominal pain, and there were dynamic changes on the electrocardiogram."

Tang Zhendong's call came in almost simultaneously.

"Qin Hai, you'd better tell me it's not the one I'm thinking of."

Qin Hai looked at the monitor.

"I hope not."

Lin Ye heard the system notification finally light up.

[High-risk segment: Group gastroenteritis complicated by dehydration and shock in elderly patients.]

[Hidden high risk: Risk of non-originating acute coronary syndrome.]

[Assessment Status: In Progress.]

In the emergency room, two elderly people were receiving intravenous fluids, one on each side.

The child was curled up on the bed with an IV drip in the back of his hand.

The man, feeling chest tightness, sat on the monitoring bed, and fear finally showed on his face.

The tour guide was still writing a list at the triage desk, and his hand was shaking so much that he wrote the wrong seat number three times.

Lin Ye looked down at the list on the wall.

The ink from that unidentified gas hasn't dried yet.

There's another one coming up.

What I saw: Many people on the same bus were vomiting and had diarrhea; the elderly had low blood pressure; and the children were lethargic.

He stopped writing here.

Before he could finish thinking about the second line, the man suddenly clutched his chest, feeling a tightness in his chest, and slumped forward.

The monitor started screaming.

Qin Hai suddenly turned around.

"Linye!"

The system countdown timer in front of Lin Ye lit up.

[High-risk deterioration due to non-homologous origin.]

[Time remaining: 09 minutes and 59 second.]

That night, they didn't get a single chance to catch their breath.