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

The young man rushed into the emergency room with the child's face pressed against his shoulder.

Her face turned bright red.

His lips, however, were bluish.

The faint sound in his throat was like something was choking him, scraping against him with every breath he took.

Nurse Zhao had just stuck the tetanus note on the wall, her hand still attached, when she immediately turned around.

How big?

"Three and a half years old!"

The young man's voice trembled as the child in his arms slumped limply downwards.

"I have a fever, and I just had a seizure at home. I can't breathe right afterward!"

People in the emergency room lobby instinctively looked this way.

Qin Hai abruptly lifted the curtain of the emergency room.

"Get him to the emergency room."

Lin Ye quickly followed.

When the child was placed on the resuscitation bed, his chest was rising and falling rapidly.

With each inhale, the area above the collarbone concaves inward.

Nurse Zhao fastened the oxygen mask, and her other hand was already connected to the finger pulse oxygen.

The numbers popped up.

88.

It's still swaying downwards.

The young man's legs went weak, and he grabbed the bed railing for support.

"Doctor, is he going to have another seizure?"

Sun Zhiqiang rushed over from the bed next to him, his medical record folder still open.

"Don't surround them yet. Step back a bit."

The child's mother also rushed in, her hair disheveled and her face covered in tears.

"He had a fever and was having convulsions! We were afraid he'd bite his tongue, so..."

She stopped abruptly halfway through her sentence.

Lin Ye looked up.

"What?"

The woman's lips trembled.

They stuffed a piece of gauze into his mouth.

The young man quickly added, "It was just a small piece, just for filling in my teeth. Then he coughed, and it looked like he spat it out."

Nurse Zhao paused.

Lin Ye's gaze fell on the child's mouth.

There was a slight dampness at the corner of her mouth.

There were white fibers stuck to the gum line.

The system notification lights up at the edge of the field of vision.

[Fourth high-risk alert activated.]

Symptoms: Fever, convulsions, and shortness of breath.

High-risk: Airway foreign body/aspiration, leading to secondary hypoxia.

[Key abnormalities: Foreign body ingestion following convulsions, inspiratory stridor, cyanosis of the lips, and decreased oxygen saturation.]

[Risk of misjudgment: Recovery period after simple febrile seizures.]

Lin Ye did not wait for the notification to disappear.

He reached out and picked up the stethoscope.

"Don't treat it as a simple seizure yet."

The young man was stunned: "What do you mean?"

As Lin Ye listened, he asked, "Is that piece of gauze intact? Where is it now?"

The woman was stunned by the question.

"I don't know... I thought it fell on the ground."

"Have you counted them?"

"Who cares about counting anymore!"

The child suddenly coughed.

The cough was very short.

It's like being stuck in traffic.

The oxygen saturation level on the monitor dropped to 85.

Nurse Zhao increased the oxygen flow rate.

"No, the oxygen level has gone up, but the numbers haven't kept up."

Lin Ye moved the stethoscope to the child's right chest.

Then move it to the left chest.

Breath sounds were noticeably weaker on the left side.

"Weak on the left side."

Sun Zhiqiang immediately took the stethoscope to review the findings.

After hearing this, his expression changed.

"There may be a foreign object."

The child's mother burst into tears.

"Didn't you have a fever? How could something have gotten inside?"

Qin Hai was already standing at the head of the bed.

"Most febrile seizures resolve on their own. The biggest problem is when family members put things in their mouths, give them water, or give them medication. During a seizure, the swallowing reflex is unstable, and if something gets into the airway, it can be fatal."

These words were like a slap in the face to the child's parents.

The young man's face was frighteningly pale.

"I don't know... My parents said they used to cushion me like this when I had muscle cramps as a child."

Nurse Zhao gritted her teeth while suctioning out oral secretions.

"Sometimes old methods don't save lives, they just make things worse."

Qin Hai didn't let her continue.

"Call pediatrics, ENT, and anesthesiology. Keep them here. Prepare for airway management. Check blood glucose, temperature, and draw blood at the bedside. First, complete the necessary preliminary tests for febrile seizures, but right now, the priority is the airway."

Lin Ye added, "Don't try to grab things blindly. Don't force your way out of things you can't see, or you'll push them in too deep."

Qin Hai glanced at him.

"Write it into the record."

Nurse Zhao has already made the call.

"Urgent pediatric consultation. The child is three and a half years old, with fever, convulsions, and wheezing. The oxygen saturation is 85 to 88. Airway foreign body or aspiration is suspected."

The second call was answered by the ENT department.

Jiang Shumin had just fallen asleep when his voice became hoarse, like sandpaper.

"Another emergency room visit?"

Nurse Zhao glanced at Lin Ye.

"Yes, but this time it wasn't the director calling out names in the group chat, it was the child who couldn't breathe."

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

Jiang Shumin's voice immediately became clear.

"Age? What is the foreign object? How much oxygen does it have?"

Lin Ye took the phone and reported quickly.

"Three and a half years old. After fever and convulsions, the family stuffed gauze into the mouth to prevent the child from biting their tongue. Afterwards, the child developed inspiratory stridor and cyanosis. The oxygen level fluctuated around 87% with oxygen saturation. Breath sounds were weak on the left side. There was fiber residue in the mouth, and it was not possible to confirm whether the gauze was intact."

Jiang Shumin uttered a very low, vulgar curse.

"Don't touch anything. Have the anesthesiologist come to the bedside and prepare the bronchoscope and foreign object removal procedure. I'll be right there."

The phone hangs up.

The child suddenly struggled again.

Her little hands gripped the edge of the oxygen mask, as if she felt stuffy.

The mother instinctively lunged at him.

Nurse Zhao blocked her way.

"Don't press him! Don't shake him! If you rush him, he'll become even more oxygen-deprived."

The mother cried so hard she could barely stand.

"I was wrong, I really didn't know I couldn't put it in..."

Lin Ye pulled her to a spot by the bed where she could see the child but wouldn't obstruct the rescue.

"Don't cry to him now. He can hear your voice, and the more chaotic you are, the more he will struggle."

The mother bit her lip hard, forcing back her sobs.

Pediatrician Liang Xiulan arrived even faster than Jiang Shumin.

She wore a white coat over a hastily thrown-on jacket, and the first thing she looked at when she entered the room was the child, and the second thing was the guardian.

"body temperature?"

Nurse Zhao: "39.2 degrees Celsius. Bedside blood sugar is normal."

Liang Xiulan bent down to check the child's reaction.

"How long did the convulsions last?"

The father immediately replied, "Two or three minutes. His eyes rolled back, and his hands and feet trembled. After we finished drawing blood, we stuffed gauze into his throat. He coughed a few times, and then his face turned blue."

Liang Xiulan's face darkened.

"Should it be inserted while you're drawing the tube, or after you've finished?"

The father got stuck.

The mother whispered, "When you smoke."

Liang Xiulan closed her eyes.

"Remember this in the future: when your child has a seizure, lay them on their side, clear any secretions from their mouth and nose, do not put anything in their mouth, do not give them water, and do not pinch their philtrum."

She didn't say much.

Because the child is starting to hold it in again.

The oxygen saturation level on the monitor dropped to 82.

The sounds in the emergency room immediately became hushed.

It's not quiet.

Everyone is waiting for the next step.

The on-duty anesthesiologist pushed the airway cart in.

Jiang Shumin also arrived.

His hair was unkempt, but his eyes were steady.

Who will treat this patient?

Lin Ye handed over the medical record folder.

"I."

Jiang Shumin flipped through the pages very quickly.

"Weak breath sounds on the left side?"

"Yes."

"Unidentified foreign object?"

"Gauze, we cannot rule out the possibility of accidental aspiration of fragments or the whole piece."

Jiang Shumin looked up at Qin Hai.

"This needs to be treated as an airway obstruction. First, stabilize oxygenation and prepare for endoscopic examination. The child is small, and crying will worsen hypoxia, so anesthesia is necessary."

Qin Hai nodded.

"You set the procedures, the emergency department will cooperate."

The father panicked when he heard "under the lens".

"Does he need surgery? He had a fever and a seizure, but it's stopped now, hasn't it?"

Jiang Shumin put on his gloves, his tone cold.

"His problem now isn't whether he can have a seizure or not, it's whether he can even catch his breath."

The father froze.

Liang Xiulan took over the conversation, her voice slightly lower than Jiang Shumin's.

"We can handle febrile seizures. What's truly life-threatening is oxygen deprivation. If there's something in the airway, and it drags on for a while, the child's brain won't be able to handle it."

The father's lips trembled slightly.

"I'll sign, I'll sign."

Nurse Zhao handed over the signature board.

This time, she didn't urge her.

I simply uncapped the pen and placed it beside him.

When my father was writing his name, the tip of his pen pierced the paper.

Before the child was wheeled into the endoscopy room, the oxygen saturation level was still hovering between 80 and 90.

Lin Ye followed beside the bed.

He saw that the child's eyelashes were sweaty and his fingers were still unconsciously gripping the sheets.

The system did not provide a more specific answer.

But the evidence is sufficient.

Foreign object entry.

Wheezing.

Cyanosis.

Weak breath sounds on one side.

The improvement was not significant after oxygen therapy.

Each one pushes the explanation of "just fever and cramps" backwards.

The door to the treatment room was closed.

The red light outside turned on.

The mother sat on a plastic chair by the door, clutching half a crumpled piece of gauze in her hand.

She had just found it in her pocket at home.

A piece is missing from the edge.

When Nurse Zhao saw this, her face turned even uglier.

"Take this in."

Lin Ye put the gauze in a transparent bag and attached the time to it.

"Show it to Director Jiang."

A dozen minutes later, the door opened a crack.

The nurse handed out a small tray.

A corner of white gauze, soaked with secretions, lay in the tray.

Very small.

But it's enough to block a child's airway.

Jiang Shumin's voice came from inside.

"It's out. There's mucosal edema near the opening of the left main bronchus. Continue oxygen therapy and observation. The pediatric and intensive care units will assess whether to transfer the patient to a more intensive care unit."

The child's mother's legs went weak, and she almost knelt down.

Her father supported her, and he himself was trembling violently.

The system notification finally lit up.

[Fourth night's additional high-risk response completed.]

The foreign object in the patient's airway has been removed, and the patient has been placed under close observation in the pediatric ward.

[Zero-fatal ER weekly progress: 4/7]

Lin Ye leaned against the wall and realized that his palms were sweaty.

Liang Xiulan came out of the treatment room and took off her mask.

"The child is stable for now. We still need to monitor for laryngeal and airway edema, infection, and recurrence of hypoxia. Don't rush to say everything is fine."

The father nodded vigorously.

"I'll remember that. If my child has cramps in the future, I won't force-feed him anything or give him water."

Nurse Zhao tore off the new sticky note and added another item to the list.

[Sudden wheezing and cyanosis after fever and convulsions: Don't just focus on the seizures; first ask if anything has been given to the baby, such as food, water, or medication, and listen for breath sounds on both sides.]

She paused after writing.

Three more words were added.

Don't reach into anything.

Qin Hai looked at those three words and didn't let her delete them.

Jiang Shumin washed his hands and came out, glancing at the list on the wall.

"This also falls under the emergency room?"

Qin Hai said, "Post the emergency version first. Come back tomorrow to get the ENT version."

Jiang Shumin sneered: "I knew it, I'd be on the list of directors who can't sleep."

Nurse Zhao capped the pen.

"Don't worry, the director's group is used to it."

Just as Lin Ye was about to speak, his phone in his pocket suddenly vibrated.

This is not the director's group.

It was a message from Liu Zhenhua.

The dean needs to review the new clauses from the first night of the trial tomorrow morning. Don't just post them on the wall; compile them into a record.

Lin Ye looked at the words, then looked up at the wall.

The two sticky notes that were just pasted on still smelled of ink.

tetanus.

Foreign body in the airway after convulsion.

On the first night of the trial run, two more items were added to the list.

The night shift isn't over yet.