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

Just as half a space was cleared at the entrance to the red zone, it was blocked by a wheelchair.

Nurse Zhao slammed on the brakes and waved to the family members first.

"You stand here. Don't try to squeeze in while explaining."

The woman was holding the registration slip, still talking.

"He usually has a sensitive stomach, and he ate cold dishes for dinner. You should give him pain relief first; he's like this when he's in pain."

The old man sat in a wheelchair, his back hunched low.

Sweat dripped down his temples from his forehead.

Qin Hai squatted down to look at him.

"Where does it hurt?"

The old man raised his hand and pressed around his navel.

"This area."

Qin Hai touched it lightly.

The old man immediately shrank back, but his hand was still pressing firmly against his stomach.

"Don't press it."

Qin Hai withdrew his hand.

"How long has it been hurting?"

The women eagerly answered.

"It took more than an hour. At first, he said he could bear it, so I told him to sit outside and wait for his number. But when I asked him to get up, he couldn't stand up."

Nurse Zhao wrapped the blood pressure cuff around her arm.

"How long has the atrial fibrillation lasted?"

The woman froze for a moment.

"It's been many years."

"Where's the medicine?"

"The anticoagulant one?"

Her voice trailed off as she finished speaking.

"He had bleeding gums a while ago, but he stopped bleeding on his own for a few days."

Qin Hai looked up at her.

"A few days?"

"About a week."

The old man had his eyes closed and his lips were pale.

"Stop asking questions, just give me pain relief first."

Lin Ye stood at the foot of the bed, holding the triage form in his hand.

The system frame is still at the edge of the field of view.

There was no countdown this time.

The disease name was not given directly.

There's only one sentence: "Insufficient publicly available evidence."

He looked at the old man's pale lips and then glanced at his blood pressure.

One hundred and sixty.

Heart rate 118.

Blood oxygen 96.

Qin Hai did not make a call immediately.

Next to him, a young man was clutching his chest while undergoing an electrocardiogram.

That was another patient who was almost mistaken for a high-risk patient just now.

At 27 years old, I experienced chest tightness, numbness in my hands, and shortness of breath.

When Lin Ye heard the words "chest tightness," he almost called the cardiologist.

Qin Hai told him to look at the evidence first.

The electrocardiogram showed no obvious signs of acute ischemia.

Blood oxygen levels are normal.

Bedside blood glucose levels are normal.

The man's fingers were numb; he had just finished arguing with his girlfriend on the phone, and his breathing was getting faster and faster.

Lin Ye did not insist on calling him "Director".

He had the nurse help him breathe slowly, and they drew electrolytes and troponin, and then repeated the electrocardiogram.

At that moment, the system did not turn red.

Qin Hai only uttered one sentence.

"If the evidence isn't enough this time, don't use your intuition as a weapon."

Lin Ye remembered it.

Therefore, he did not directly diagnose the elderly with a specific disease.

He simply handed over the triage form.

"Atrial fibrillation, stop anticoagulation for a week. Abdominal pain for more than an hour, cold sweats. Strong response to pressure, but the abdomen is not rigid. First, do bedside blood gas analysis to check lactate, and send venous blood for electrolytes, coagulation, liver and kidney function tests, and also do an electrocardiogram."

Qin Hai took the order.

"This sentence can be said."

Nurse Zhao had already torn open the packaging of the blood collection needle.

"Draw arterial blood gas?"

Qin Hai nodded.

"Draw blood. Establish an intravenous line and draw blood. Don't just give a painkiller injection and put it back in."

The woman became anxious.

"Why can't we stop the pain first? He's in so much pain."

Qin Hai didn't look up.

"It's not that we won't give you painkillers, but we need to get the physical exam, blood gas analysis, and the people we need to call up first. We can give you painkillers, but after giving them, we can't just send you back to the waiting room with stomach pain. You just said he couldn't stand up, and that's more important than stomach pain."

The woman stopped holding the registration slip.

The old man curled up again.

"My stomach feels twisted."

Nurse Zhao held his wrist steady.

"Don't move, finish this tube first."

The blood collection tube made a very soft sound when it hit the tray.

The young man also spat out the electrocardiogram paper.

The emergency room doctor glanced at it and handed it to Qin Hai.

"The follow-up examination still showed no significant dynamic changes, and the blood oxygen level remained stable."

The young man lay on the bed, his face still a little pale.

"Doctor, am I having a heart attack?"

Qin Hai handed the electrocardiogram back.

"The evidence doesn't seem to suggest it right now. Observe first, don't scare yourself. If the chest pain worsens, you sweat, or the electrocardiogram changes, then get checked again immediately."

The young man breathed a sigh of relief.

His friend, who was with him, also relaxed.

"I was so scared just now, I thought they were going to call the director again."

Nurse Zhao looked up from the old man's side and glared at him.

"The emergency room isn't a competition for the chief physician."

As soon as he finished speaking, the blood energy mechanism started beeping.

The little note was slowly spit out.

Lin Ye walked over and waited until the paper was completely expelled before reaching out and tearing it off.

The paper strip was still warm from the machine.

He noticed pH first.

Then we see lactic acid.

The note paused for a moment in his hand.

Lactic acid five point six.

Nurse Zhao came over.

"How many?"

Lin Ye handed the note to Qin Hai.

"Lactic acid five point six."

Qin Hai took the note, and the slight relaxation on his face completely disappeared.

He looked at the old man.

The elderly man was still in a wheelchair. His stomach was not noticeably swollen, he was not vomiting blood, and he did not have a fever.

But the blood gas strip had already torn away the "stomach pain" layer from the waiting area.

Qin Hai placed the note on top of the triage form.

"Push the bed in the red zone."

The woman was momentarily stunned.

"Didn't you say your blood pressure was okay?"

"Your blood pressure is okay, but that doesn't mean your stomach is fine."

Qin Hai turned his head.

"Lin Ye, check the medications. Ask about the anticoagulant discontinuation time, atrial fibrillation history, and any history of thrombosis. Zhao, draw blood for coagulation, liver and kidney function, and electrolytes, and prepare crossmatching samples. Attach the bedside ECG."

Nurse Zhao responded as she pushed the bed.

"Know."

Lin Ye walked up to the woman.

"What's the name of the anticoagulant he usually takes?"

The woman was immediately stumped by the question.

She looked down and rummaged through her bag, pulling out a crumpled medicine bag.

Half of the words on the medicine bag were worn away.

"I don't know if it's this one. He manages his own medication."

Lin Ye took the medicine bag.

There were still a few pills left inside.

"Do you have a history of bleeding, thrombosis, cerebral infarction, or myocardial infarction?"

"I haven't had a stroke. My leg was swollen once before; the doctor said it was due to poor blood vessel health."

Qin Hai looked up when he heard this.

Which leg?

The woman panicked.

"Right leg or left leg, I can't remember."

When the old man was transferred to the gurney, he suddenly grabbed the bed sheet.

His voice was distorted from the pain.

"My stomach hurts, why are you asking about my legs?"

Qin Hai connected the monitoring line.

"Because it hurts a bit, it's not my stomach acting up."

The blue text box only deepened at the edge of my field of vision.

[Emergency Room Warning: High Risk of Non-Infectious Abdominal Pain]

[The evidence provided includes: history of atrial fibrillation and discontinuation of anticoagulation, abdominal pain that does not match the abdominal signs, cold sweats, increased heart rate, and significantly elevated lactate levels.]

[Risk aspect: Potential for mesenteric vascular emergency, requiring imaging and specialist evaluation.]

Lin Ye did not utter the words "membranes".

The evidence still needs to be collected.

He pressed the bloody note onto the first page of the medical record folder.

"Director Qin, with lactate levels, history of discontinuing atrial fibrillation medication, and discrepancies between pain and physical examination findings, who should be called upon?"

Qin Hai had already picked up the phone.

"General surgery on-call doctor, vascular surgery on-call doctor, CT room."

Before the call was connected, he added one more sentence.

"Don't talk about the diagnosis yet. Talk about the person, the numbers, and stopping the medication."

Lin Ye nodded.

The moment the call was answered, Qin Hai's voice was already drowned out.

"Emergency red zone, male in his sixties, sudden abdominal pain, atrial fibrillation, stopped anticoagulation for a week, lactate 5.6. Blood pressure is temporarily stable, but the pain is not right."

The person on the other end of the phone was initially a bit lazy.

Upon hearing the lactate level of 5.6, the sound of a chair being dragged immediately rang out.

"I'm coming down."

Qin Hai didn't die.

"The vascular surgery department was also called. The CT room is preparing for abdominal CT angiography, and kidney function tests are being conducted simultaneously. The risks of the angiography will be explained at the same time."

The woman stood at the foot of the bed, finally ceasing her urging for pain relief.

As she stared at the still-warm, bloodstained note, the color drained from her face.

"Doctor, doesn't he have a stomachache?"

Qin Hai hung up the phone.

"We can't let him go just because he has a stomachache."

The flatbed cart was pushed into the red zone.

The old man was curled up in bed, his hand still pressing on his stomach.

As soon as the monitor was connected, the heart rate jumped to 124.

Blood pressure is 98.6.

Nurse Zhao tightened the cuff again.

"It was 106 just now."

Qin Hai looked at Lin Ye.

"Record the time."

Lin Ye lowered his head and wrote.

11:42 PM.

Patients with abdominal pain are moved from the waiting area to the red zone.

Lactic acid five point six.

The on-call doctors in general surgery, vascular surgery, and the CT room have been notified.

He had just finished writing when the CT room called back.

"This bed in the emergency room can come over, but there's another one that was just wheeled in. Can you wait ten minutes?"

Qin Hai looked at the heart rate monitor, which had jumped again.

There was no immediate response.

Lin Ye's pen stopped on the paper.

ten minutes.

This brief moment felt like stepping into the lights of the red zone.