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

The sound of a trolley pushed over from the other end of the emergency room.

The wheels were running too fast, and the front wheel hit a crack in the paving stones with a dull thud.

As Lin Ye followed Qin Hai through the corridor, the 120 emergency medical personnel had already pushed the stretcher to the triage desk.

The man on the flatbed cart was over sixty years old.

He is very thin.

But her belly was swollen.

He curled up under the thin blanket, his hands pressed tightly against his lower left abdomen, the edges of his fingernails turning white.

His face was ashen, as if he had just been pulled out of the water.

A middle-aged woman was running alongside him, one of the buttons on her coat was fastened incorrectly.

He was also carrying a half-empty bag of Huoxiang Zhengqi Water.

The bottles inside the plastic bag were clattering against each other, making a rattling sound.

"Doctor, he just has food poisoning!"

The woman's voice was very high-pitched.

"He said his stomach hurt this morning and had diarrhea once. I gave him some medicine, but the pain got worse."

The paramedics hung the oxygen bag on the bed rail.

"My blood pressure was low on the way here. It started at 86 or 50, and just now it was 78 or 46. My heart rate was 130, and I was sweating profusely."

Qin Hai didn't stop walking.

"Red Zone".

Nurse Zhao rushed out of the nurses' station, still holding the tape in her hand.

"Family members, please move aside."

The woman froze.

"Isn't it gastroenteritis? How come it's in the red zone?"

No one answered her first.

As the stretcher was pushed into the emergency position, the leg of the bed hit the metal strip on the ground with a loud bang.

When the thin blanket was lifted, a smell of cold sweat mixed with the cloying sweetness of Huoxiang Zhengqi Water (a traditional Chinese medicine) wafted out.

The man's lips were purple, and his forehead was covered in sweat.

He wanted to speak.

He opened his mouth, but only managed to let out a muffled groan.

Nurse Zhao wrapped the cuff.

The sound of the Velcro being torn was like a piece of cloth being ripped apart.

Blood pressure 76/44.

Heart rate 138.

Blood oxygen 96.

Body temperature 36.3.

Blood sugar 6.8.

Qin Hai glanced at the numbers.

"Two intravenous access lines. Blood draw: complete blood count, liver and kidney function tests, electrolytes, coagulation, lactate, amylase, troponin; blood type crossmatching to be prepared. Bedside blood gas analysis."

Nurse Zhao has already placed the indwelling needle onto the treatment tray.

The needle cap rolled around once and came to a stop hitting the edge of the plate.

"Know."

The woman stood at the foot of the bed, her eyes still fixed on the bag of medicine.

"He ate leftover cold food this morning, he must have gotten sick. He's never had a good stomach before."

Lin Ye looked at the hospital bed.

The man's hand was not on his stomach.

It should be pressed on the left side of the navel.

The pain made me curl up to my left.

His trousers were loose at the waist, and his abdominal skin was shiny with sweat.

This is not the typical collapse following diarrhea.

Lin Ye reached out and touched the back of his hand.

Icy.

wet.

The radial artery is so thin it looks like a thread about to break.

"What's your name?"

The man couldn't answer.

The woman hurriedly said, "Liang Shumin, sixty-four years old."

"How long will the pain last?"

"Almost an hour."

"How many times did you poop?"

Just once.

"Did you throw up?"

"I didn't vomit."

"Is there any black stool? Blood in the stool?"

The woman shook her head.

"No, I just have a stomachache."

Qin Hai put on gloves and pressed down on Liang Shumin's abdomen.

The moment the touch reached his lower left abdomen, the man jerked violently.

He crumpled the bed sheet into a ball.

"pain!"

Qin Hai did not press his hand down any further.

He moved it to the area around the navel.

The man's abdomen was taut.

It's not the kind of swelling that comes from air.

It looks like there's something pressed down inside.

Lin Ye stood on the other side, his gaze falling on the man's midline.

Beneath the skin, there was a faint pulsation.

Not obvious.

But as the monitor beeped, it gently pushed against me.

His heart sank.

Just then, a light blue border popped out next to the emergency bed.

[High-risk warning: Low blood pressure, abdominal pain, and signs of shock.]

[Possible cause: Risk of ruptured abdominal aortic aneurysm or massive intra-abdominal hemorrhage.]

[Current Risk: Hemorrhagic shock.]

[Recommendation: Based on physical examination, bedside ultrasound, hemoglobin, lactate, imaging, and specialist evaluation.]

Lin Ye didn't look up for long.

He turned his gaze back to the patient.

That warning simply highlighted the risk.

What can get the emergency room moving is these things right in front of you.

Low blood pressure.

cold sweat.

Sudden abdominal pain.

The pulse is weak.

Abdominal pulsation.

"Director Qin."

Lin Ye's finger landed on Liang Shumin's navel, slightly to the left.

No pressure was applied.

It just stayed there.

"There's a pulse here. With such low blood pressure and sudden abdominal pain, it doesn't seem like a simple case of food poisoning."

Qin Hai's expression changed instantly.

He looked up at Nurse Zhao.

"Bring the bedside ultrasound. Notify the vascular surgery department; suspected ruptured abdominal aortic aneurysm. Have someone taken downstairs. CT room alert; prepare for aortic CT angiography, with monitoring en route."

Upon hearing the word "rupture," the woman dropped the plastic bag she was holding to the ground.

A bottle of Huoxiang Zhengqi Water rolled out.

The bottle hit the foot of the bed with a thud.

"What's broken?"

Her voice changed.

"He just has a stomachache!"

Nurse Zhao didn't even look up while giving the injection.

"Stomach aches vary in severity. If your blood pressure drops like this, don't immediately assume it's just food poisoning."

The needle tip enters the blood vessel.

Health recovery is very slow.

Nurse Zhao frowned.

Poor peripheral circulation.

She pressed the tape down.

"Another way."

Sun Zhiqiang took over the second vein from the side.

"Vascular surgery hotline."

Qin Hai accepted it.

There was the background noise of an operating room on the other end of the phone.

"The patient with the lower limb injury was being prepared to be transferred to the operating room. What's wrong with your emergency room?"

Qin Hai speaks very quickly.

"A 64-year-old male presented with sudden abdominal pain for one hour. His blood pressure was 76/44, heart rate was 138, he was sweating profusely, and there was a suspected pulsating mass in his abdomen. We suspect a ruptured abdominal aortic aneurysm or massive intra-abdominal hemorrhage. One vascular surgeon has been dispatched."

There was a half-second silence on the other end of the phone.

"Don't let him move it around. Check with bedside ultrasound first. If the blood pressure can be maintained, proceed directly to aortic CT angiography. If it can't be maintained, conduct bedside assessment and then proceed with the emergency treatment procedure. I'll call someone immediately."

Qin Hai hung up.

The bedside ultrasound machine was brought over.

The wheel rolled over the medicine bottle that had just fallen out, and the bottle was squeezed into the corner with a snap.

Lin Ye bent down, picked it up, and threw it into the bag at the foot of the bed.

The woman watched his movements and then realized that the bag of medicine was useless.

Qin Hai pressed the probe against his abdomen.

The coupling agent was squeezed out, and its coolness made Liang Shumin shiver all over.

"Don't move."

Qin Hai stared at the screen.

The screen's light shone on his face.

The vascular images slowly emerge from the gray and white noise.

Sun Zhiqiang came closer.

"The abdominal aorta is wide."

Qin Hai did not draw a conclusion immediately.

The probe slid to the side.

Next, continue.

His hand movements became slower and slower.

On the screen, a segment of the abdominal aorta is clearly dilated.

There was also a dark area that shouldn't have been there.

Qin Hai looked up.

"Possible abdominal aortic aneurysm, surrounded by a fluid-filled dark area. Proceed according to the risk of rupture."

The woman's face went blank.

"A tumor? When did he get a tumor?"

"Many people don't know this in normal times."

Qin Hai handed the probe to Sun Zhiqiang, asking him to continue fixing the image.

"The issue isn't about when it happened. The issue is that my blood pressure is dropping."

The monitor seemed to echo his words.

The dripping sound became more urgent.

Blood pressure 72/40.

Heart rate 142.

Liang Shumin's eyes were half-open.

He stared at the ceiling, his pupils slightly dilated.

"I... am cold."

Nurse Zhao pulled the thin blanket up.

"Don't sleep."

She patted him on the shoulder.

"Say hello if you can hear me."

Liang Shumin's lips moved slightly.

No sound was made.

Lin Ye glanced at the blood aura sheet.

The paper strips that the machine just spat out were still warm.

pH 7.31.

Lactic acid 4.6.

The hemoglobin hasn't returned yet.

"Lactic acid 4.6%"

He handed the paper to Qin Hai.

"The evidence of shock has been confirmed."

Qin Hai glanced at it.

"Prepare blood to induce aspiration."

Nurse Zhao immediately called the laboratory.

"Liang Shumin from the red zone, urgent cross-matching required. Not ordinary abdominal pain, suspected massive bleeding."

I don't know what was said on the other end of the phone.

She lowered her voice.

"Yes, the vascular surgery department has already been contacted. Let's move forward with the blood type and crossmatching."

The woman stood to the side, her fingers gripping the bag strap.

She tore the bag strap until it was deformed.

"Doctor, will he die?"

There was a brief pause next to the emergency room after the question was asked.

It's not that nobody wants to answer.

Everyone has something to do that can't be stopped.

Qin Hai saved the ultrasound images.

"His life is in danger."

He said.

"But since the person is still in our hands, let's proceed with the fastest possible procedure."

The woman's lips trembled.

"Do I need to sign?"

"He is currently unconscious and in critical condition."

Qin Hai looked at her.

"As a family member, please cooperate and provide informed consent first. Emergency treatment cannot wait. Once the vascular surgeon arrives, they will continue to explain the risks if surgery is required."

The woman nodded.

He shook his head after ordering.

"His son is out of town, so I have to make a phone call."

"beat."

Qin Hai said.

"But don't leave. Put the phone on speakerphone; I need you to confirm my medical history if necessary."

The woman frantically flipped through her contacts.

There was an old crack on the phone screen, and it got stuck when I swiped my fingertip across it.

Lin Ye continued to ask.

Does he have high blood pressure?

"have."

The woman answered the call while dialing.

"Irregular medication use."

"Smoking?"

"I've been smoking for over thirty years."

"Has your previous physical exam mentioned an abdominal aortic aneurysm? Are there any large blood vessels in your abdomen?"

The woman looked at him blankly.

"Nobody said that."

The call was connected.

The sound of a young man just waking up came from across the street.

"mom?"

The woman burst into tears as soon as she heard the voice.

"Your dad is in the emergency room. The doctor said a blood vessel in his abdomen might have ruptured..."

Qin Hai reached out his hand.

"Give me."

The woman handed over the phone.

Qin Hai pressed the speakerphone button.

"This is Qin Hai from the Emergency Department of the First Municipal Hospital. Your father is currently experiencing sudden abdominal pain and low blood pressure. Bedside ultrasound indicates a risk of ruptured abdominal aortic aneurysm. He is being resuscitated and we are in contact with the vascular surgery department. Your mother is on site. We need you to keep your phone accessible to provide further information on her medical history and medications."

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

Only the sound of breathing remained.

Two seconds passed.

"Doctor, I'll buy a ticket and come back now."

"Can."

Qin Hai said.

"But the emergency treatment can't wait for you to arrive. You should answer the phone first."

When the vascular surgeon arrived, he hadn't even fully put on his coat.

He was holding the surgical cap he hadn't had time to put down earlier, his name tag askew on his white coat.

Upon entering, the first thing to do is check the guardian.

Let's look at the ultrasound images again.

What is your blood pressure?

Nurse Zhao reports.

"72.40, heart rate 142, lactate 4.6, blood type crossover is in progress."

The vascular surgeon pressed the probe back down, looked at it for a few seconds, and then his expression darkened.

"The risk of an abdominal aortic aneurysm rupture is very high."

He turned to look at Qin Hai.

"Can the CT scan handle it?"

Qin Hai glanced at the monitoring device.

"Your blood pressure is too low. Fluid resuscitation and blood transfusion have been initiated, and vasopressors are ready. There's a high risk of a breakdown on the way."

The vascular surgeon clenched his back molars.

"Notify the operating room and anesthesiology department first. If the blood pressure can be maintained, proceed with aortic CT angiography; if not, proceed directly with the emergency procedure for a ruptured aneurysm."

After he finished speaking, he looked at the family members.

"Are you the wife?"

The woman nodded.

The vascular surgeon slowed down the sound.

"We suspect that a major blood vessel in his abdomen has ruptured and is bleeding. This is a very dangerous condition, and we need to prepare for surgery or assess endovascular repair immediately. We will continue to treat him while determining whether a CT scan can pinpoint the location."

The woman was holding her phone.

The son on the other end of the phone was also listening.

"Can it be saved?"

Vascular surgeons don't just talk the talk.

"There's a chance, but the risks are huge. Every minute counts now."

The woman's hand slowly loosened.

The phone almost fell.

Lin Ye reached out and took the phone, placing it on the small table beside the bed and turning it on speakerphone.

"The family members are listening."

The vascular surgeon nodded.

"it is good."

He looked at Qin Hai.

"Call the operating room, anesthesiology department, and blood transfusion department."

Qin Hai had already picked up the phone.

"The duty officer also reported it."

Nurse Zhao tore off a new label and stuck it on the blood collection tube.

The label wasn't stuck on properly, so she pressed it down hard with her fingertip.

"If blood comes in, which axle should be treated first?"

Qin Hai didn't even glance at it.

"The thick needle route. The other route is for medication. Leave a catheter in place and record urine output."

Sun Zhiqiang spread out the rescue record paper.

The paper was tucked under the monitor base to prevent it from being blown away by the wind.

Lin Ye looked at Liang Shumin.

The man's hand was still pressed against his abdomen.

But I have less strength than before.

The fingertips slowly loosened.

The light blue border at the edge of the field of vision lit up briefly.

[Current Status Update: Suspected ruptured abdominal aortic aneurysm has been admitted to the emergency resuscitation process.]

[Risk: Hemorrhagic shock, which may worsen during transport.]

[Result: Still under evaluation.]

Still under evaluation.

Lin Ye took a breath.

In the emergency room, the infusion pump, monitor, telephone ring, and the suppressed sobs of family members were all crammed together.

This isn't an upset stomach.

Blood pressure doesn't lie.

Cold sweat doesn't lie.

The dark area seen on bedside ultrasound doesn't lie.

A few minutes later, the blood transfusion department called back.

The first bag of blood is being delivered.

The anesthesiology department replied that they had already sent him to the emergency room.

The operating room staff will determine whether to proceed with open surgery or endovascular repair.

Each phone call is like a rope.

Pull Liang Shumin up a little from where he was falling.

But not enough.

Blood pressure remains at 78/46.

The vascular surgeon stared at the monitor, his jaw clenched.

"Wait for another bag of blood."

He said.

"If my blood pressure isn't high enough, I won't risk getting a CT scan."

Qin Hai nodded.

"Stabilize the patient in the emergency room first."

The woman held her phone, her knees slowly bending down, almost falling to the ground.

Nurse Zhao caught her.

"Don't spill it."

The woman looked up, her face streaked with tears.

"I just gave him some Huoxiang Zhengqi Water (a traditional Chinese medicine)."

Nurse Zhao didn't scold her.

She simply helped the person to a chair by the wall.

"Don't think about that now. Think about your medical history. Have you taken any anticoagulants? Have you had any stents implanted? Do you have any allergies?"

A woman wipes her eyes with her sleeve.

"No stent. Penicillin allergy. Taking blood pressure medication haphazardly."

Nurse Zhao turned around.

"Allergic to penicillin, irregular blood pressure medication."

Lin Ye wrote on.

The pen tip had just touched the paper.

Someone else ran in through the door of the emergency room.

It's Ma Hao.

He was holding up a newly printed test report.

"Lin Ye, the hemoglobin has returned."

Lin Ye accepted it.

The paper is still warm.

The numbers above are so glaring they make your eyes water.

Hemoglobin 78 grams per liter.

He looked up.

Qin Hai saw it too.

The vascular surgeon only asked one question.

"Has the blood arrived?"

At the end of the corridor, the blood transfusion department's cold chain box was being carried along by someone.

The box bumped into the corner of the nurses' station.

With a bang.

Nurse Zhao reached out and caught it.

"They're here."

The vascular surgeon looked at Qin Hai.

"Drip blood, raise blood pressure, and take the anesthesia directly to the operating room after it arrives."

Qin Hai nodded.

"Is it not possible to perform CT angiography of the aorta?"

The vascular surgeon looked at the fluctuating blood pressure curve on the monitor.

"No, we won't wait."

His voice was very low.

"If we wait any longer, we might not even get to the operating room."