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

The receiver picked up static from the radio of the rural ambulance, and the accompanying doctor's voice was hoarse and urgent.

"General Manager Lin! An ambulance from Hongxing Township Health Center is carrying a critically ill 52-year-old man! He drank homemade liquor this evening, fell in the cornfield, and vomited violently after returning home. He's now unconscious and unresponsive! We've administered glucose and naloxone for severe alcohol poisoning, but his heart rate is getting slower and slower, and his blood pressure has spiked to almost 200. We can't handle it; the ambulance has already entered the gate!"

The sound of brakes came from outside the door.

A bread ambulance covered in yellow mud slammed on the brakes on the slope.

The car door opened, and a middle-aged man in his fifties was pushed off the bus. His face was ashen, and he was snoring heavily like a bellows.

The peasant woman, her hands covered in black mud, followed behind the car, crying out:

"Doctor! Help! He can usually drink a pound of liquor and not get drunk, but today I don't know what's wrong with him. He's lying down and I can't wake him up, and he keeps spitting out acidic fluid..."

"Move into Emergency Room One and take over monitoring!"

Lin Ye quickly stepped forward, the red armband on his left arm that read "Cangshan County People's Hospital Night Medical Duty Officer" standing out prominently under the light.

The stretcher was pushed into the emergency room.

The nurse quickly cut open the sleeve and connected the monitoring leads.

A set of glaring vital signs popped up on the monitor screen:

Blood pressure: 188/110 mmHg;

Heart rate: 46 beats/min;

Blood oxygen saturation: 91%;

Breathing: 9 breaths/min, deep and slow breathing with irregular pauses.

The accompanying doctor, panting heavily, held up the IV bag: "Mr. Lin, we added naloxone to his drink on the way here to help him wake up, but there was no response at all. The alcohol is too strong..."

"Pull it out!"

Lin Ye directly removed the glucose puncture needle.

"The injured person was vomiting and dehydrated, with a heart rate of only 46 beats per minute. He also exhibited abnormal bradycardia accompanied by malignant hypertension and deep, slow breathing, which is a typical Cushing's triad. The high intracranial pressure was compressing the vital centers in the medulla oblongata, and the low osmotic glucose would worsen the cerebral edema."

The accompanying doctor was so frightened that he took a half step back.

Lin Ye took the pupil pen from his chest and used his left thumb to lift the wounded man's left eyelid.

The left pupil is 2.5 mm in diameter and reacts readily to light.

Lin Ye moved his fingers and lifted the wounded man's right eyelid.

The moment the light spot fell, Lin Ye's eyes narrowed slightly.

The right pupil had dilated to 4.5 mm, with its edge close to the outer periphery of the iris, and showed no contraction response under direct strong light.

The pupils are unequal in size, and the direct and indirect light reflexes on the right side are completely absent.

Lin Ye extended his right hand and inserted his five fingers deep into the hairline on the right side of the injured person to perform palpation.

Slide your fingertip along the temporal bone suture and you'll find a soft, fluctuating scalp hematoma about the size of an egg, three centimeters above the right ear and above the zygomatic arch.

When the cotton swab is moved along the outer edge of the left foot, the big toe slowly dorsiflexes and the other four toes fan out. The Babinski sign on the left side is strongly positive, and the pyramidal tract on the contralateral side is damaged!

Lin Ye looked at the peasant woman.

"When he fell in the evening, was he unconscious for a few minutes? After waking up, was he able to walk home on his own, and only after an hour or two did he suddenly experience a headache, vomit, and fall into a coma?"

The peasant woman was stunned, and nodded repeatedly:

"Yes! He fell on a rock and was dizzy for a little while, but then he got up and said he was fine. He even drank half a bowl of porridge when he got home. Almost two hours later, he suddenly started rolling on the ground, clutching his head and yelling in pain. Then he vomited violently and couldn't be woken up!"

"A period of lucidity in between!"

Lin Ye put away the pupil pen, his expression serious.

"The fracture of the right temporal bone tore the middle meningeal artery, and the high-pressure arterial blood rapidly accumulated in the epidural space, forming an acute epidural hematoma! The uncus of the temporal lobe has been compressed and herniated into the tentorial notch of the cerebellum, compressing the oculomotor nerve and the brainstem."

At the edge of my field of vision, extremely faint countdown numbers appeared:

【00:14:28】

Only fourteen minutes!

Once the brainstem is compressed and a foramen magnum herniation occurs, breathing will stop instantly and irreversibly!

Liang Shumin, who had rushed over, pushed open the door and entered. Upon hearing the diagnosis, her expression changed: "Cerebellar tentorial herniation! A head CT scan is necessary immediately to assess the amount of bleeding and midline shift. We need to notify them immediately to perform craniotomy!"

"Use the radiology department's fast track!"

Lin Ye pushed open the door to the emergency room.

The flatbed cart sped along the corridor toward the radiology department at the back.

However, when they reached the CT room, their steps suddenly froze.

The iron gate was secured with a brass lock, and the computer room was pitch black inside!

The nurse pounded on the iron gate urgently, the chains clanging loudly: "Is anyone there! Emergency CT scan! Open the door!"

The room inside was deathly silent.

Another nurse ran over, covered in sweat, holding a stethoscope:

"Mr. Lin... CT technician Xiao Liu is on standby tonight. To save electricity, the county hospital doesn't keep anyone in the CT room at night, so the technician is at his home in the south gate of the county town. I just got out of bed and was getting dressed; it will take him at least 25 minutes to get here on his electric scooter!"

Twenty-five minutes! It will take another five to ten minutes for the machine to warm up!

The wounded soldier's right pupil was already completely dilated, and there were only thirteen minutes left on the countdown!

"We can't just wait in the hallway."

Lin Ye immediately turned the car around: "Back to Emergency Room One!"

The trolley was pushed back to the emergency room.

Lin Ye gave medical orders while pushing the cart:

"First, elevate the head of the bed by 30 degrees to increase venous return from the jugular vein."

"Second, 250 ml of 20% mannitol, put it in an inflatable pressure bag, and push it in at full speed within 15 minutes."

"Third, administer 100 ml of hypertonic saline solution via intravenous pump for double dehydration and reduction of intracranial pressure."

"Leave the airway to me!" Liang Shumin stepped forward quickly, picked up the video laryngoscope, and said, "The breathing rhythm is disordered, establish an artificial airway immediately."

The catheter is precisely passed through the glottis and connected to the breathing bag.

"Hyperventilation, oxygen administration!" Lin Ye stared intently at the monitor. "Increase the ventilation rate to 16 to 18 breaths per minute, reduce the carbon dioxide partial pressure to 30 mmHg, and constrict cerebral blood vessels to reduce intracranial pressure!"

Rapid dehydration and ventilation take effect quickly.

The blood pressure on the monitor dropped from 188 to 168 mmHg, but the dilated right pupil did not shrink at all.

Zhao Feng rushed into the emergency room carrying a first-aid kit, glanced at the pupils, and looked grave.

"Dehydration is just a temporary measure to buy time! The arterial bleeding continues, and the hematoma is pressing firmly against the brainstem! The hematoma must be removed and decompression relieved within half an hour! Where is the neurosurgeon at the county hospital?"

Guo Shusen strode in.

"The county hospital's neurosurgery department only has one deputy director, who has been transferred to the provincial capital for further training! Tonight, only general surgery and orthopedics specialists are on duty; there are no specialists capable of performing craniotomies with a skull drill!"

"No specialist doctors?"

"Transfer to the First Municipal Hospital? Ambulance with sirens blaring!"

Guo Shusen said urgently.

"It's a winding mountain road, it'll take at least an hour and a half to get to the city!" Lin Ye interrupted. "The countdown isn't even ten minutes left. If the car doesn't even make it out of the county, my brain will be crushed, I'm definitely going to die!"

A CT scan cannot be performed immediately at night!

No neurosurgeons!

Unable to ship out!

Three fatal weaknesses, like an iron net, drove the dying farmers into a desperate situation.

Zhao Feng gritted his teeth: "I am an attending general surgeon and can open the abdomen to connect blood vessels, but I have never opened the skull! Without CT guidance, blindly drilling through the skull could cause fatal bleeding on the spot if the drill deviates and punctures the main blood vessel."

Lin Ye stood beside the bed, his fingers pressing on the slightly warm scalp hematoma on the right temple of the wounded soldier.

You can clearly feel the faint high-pressure pulsation coming from deep within the bone joints at your fingertips.

In top-tier hospitals, neurosurgery has strict specialist admission requirements, but in a county hospital at night, following the dogma is tantamount to watching someone die!

Without hesitation, Lin Ye took out a red business card from the inside pocket of his white coat.

That was the emergency hotline card that Liu Zhenhua, deputy director of the medical affairs department of the First Municipal Hospital, personally handed to him before he set off.

Lin Ye grabbed the red secure phone and dialed the number on the card directly to speakerphone.

The clicks of the buttons rang crisply in the deathly silent emergency room.

After just two rings, a deep, hoarse voice came through the receiver:

"Who is this? I am Luo Jianping from the Department of Neurosurgery at the First Municipal Hospital."

Luo Jianping, a top neurotrauma expert in the province and the chief of neurosurgery at the First Municipal Hospital!

Lin Ye straightened up and spoke very quickly into the receiver.

"Director Luo! This is Lin Ye from the Emergency Department of the First Municipal Hospital, currently on night duty at Cangshan County Hospital!"

"Cangshan Hospital admitted a 52-year-old trauma patient with a right temporal contusion. The patient had a typical lucid interim period, a right pupillary dilation of 4.5 mm with no pupillary light reflex, a positive Babinski sign on the left side, and Cushing's triad. The patient was suffering from acute epidural hematoma complicated by uncus herniation of the temporal lobe and was in critical condition!"

Lin Ye took a deep breath.

"The nighttime CT scanner in Cangshan cannot be turned on immediately, the technician is still on his way back to the hospital, there are no neurosurgeons in the entire hospital, and the injured cannot endure an hour and a half of mountain road transport! I request the Department of Neurosurgery of the First Municipal Hospital to urgently open a remote guidance channel so that I and Zhao Feng, the attending physician of general surgery, can urgently perform cranial drilling drainage decompression surgery at the bedside."

On the other end of the phone, the steady breathing suddenly stopped!