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

As the man, feeling a tightness in his chest, stumbled forward, Nurse Zhao caught him by the shoulder.

The vomit bag fell from his hand.

It's empty inside.

He never vomited.

The monitor jumped upwards with a scream.

Heart rate 127.

Blood pressure is 94.6.

The man was covered in cold sweat, his lips were pale, and his right hand was pressed tightly against his upper abdomen.

"It hurts...it hurts here..."

He was referring to the stomach.

But Lin Ye wasn't looking at his hands.

It's the increasingly chaotic rhythm on the monitoring screen.

Qin Hai had already placed the electrocardiogram chart next to the bed.

"Lie flat, administer oxygen, and keep the monitoring on. Perform a repeat 12-lead ECG."

The man struggled for a moment.

"I...I have diarrhea..."

Nurse Zhao held him down.

"You didn't poop."

These three words are more powerful than any explanation.

The man paused for a moment.

Lin Ye leaned down and asked, "Does your chest feel tight? Does the pain radiate to your left shoulder, back, or jaw?"

The man was breathing rapidly.

My back... my back is sore too...

Qin Hai looked at Lin Ye.

"Take further medical history."

Lin Ye immediately turned to the tour guide.

"What's his name?"

The seating chart in the tour guide's hand trembled loudly.

"Jiang, Jiang Lei, thirty-six years old, sitting in the seventh row by the window."

"Has he vomited or had diarrhea?"

The tour guide looked at the other tourists in a panic.

A man in the same car raised his hand.

"He didn't have diarrhea or vomit. He kept saying his stomach hurt, so I gave him two stomach pills."

Qin Hai's face darkened.

"What stomach medicine did you take?"

"Like, the aluminum magnesium carbonate kind."

Lin Ye continued to ask Jiang Lei questions.

Do you have high blood pressure, diabetes, or smoke?

Jiang Lei was in so much pain that the veins on his forehead were bulging.

"High blood pressure...not taking medication...smoking, more than a pack a day..."

Nurse Zhao's lips tightened.

"At thirty-six, it won't stop your blood vessels from getting blocked."

The follow-up electrocardiogram results are in.

Qin Hai's expression changed as soon as he spat out half of the paper.

The changes were more pronounced in the inferior leads.

It's no longer just a sign.

Lin Ye saw the system countdown jump to eight minutes and twenty-one seconds.

Tang Zhendong practically stormed in.

One of the buttons on his white coat was fastened incorrectly.

Where are they?

Qin Hai handed over the electrocardiogram.

"He was caught in the bus group diarrhea outbreak. He experienced chest tightness, upper abdominal pain, sweating, but no diarrhea, and his electrocardiogram showed dynamic changes."

Tang Zhendong's face darkened after just one glance.

"High suspicion of acute inferior coronary syndrome. Has troponin returned?"

Sun Zhiqiang shouted from in front of the computer.

"The first batch hasn't been shipped yet."

Tang Zhendong looked at Jiang Lei.

"How long has it been hurting?"

Jiang Lei gritted his teeth.

"After more than half an hour... it's getting more and more painful..."

"Have you vomited blood or had black stools? Have you had any recent surgeries, brain hemorrhages, or gastrointestinal bleeding?"

Jiang Lei shook his head.

"No……"

Tang Zhendong turned to Nurse Zhao.

"Establish a second intravenous access, draw blood for clotting and liver/kidney function tests. Prepare aspirin, clopidogrel, and statins, and confirm contraindications first. Notify the catheterization lab on-call staff."

The tour guide turned pale when he heard "catheterization room".

"Doctor, didn't he have food poisoning? Why does he need to go to the catheterization lab?"

Tang Zhendong turned to look at him.

"Eating an upset stomach won't make your electrocardiogram look worse."

The tour guide shut up.

Jiang Lei's phone rang in his coat pocket.

Nurse Zhao took it out and glanced at it.

"Wife."

Jiang Lei was in so much pain that he couldn't even open his eyes.

"No...don't answer...it'll scare her..."

Tang Zhendong said coldly, "If you don't answer now, things will get even more frightening later."

Qin Hai took the phone and put it on speakerphone.

The person on the other end of the phone was a woman, and her voice still sounded sleepy.

"Jiang Lei? You've arrived at the hotel?"

Qin Hai immediately stated his identity.

"This is the emergency room of the First Municipal Hospital. Jiang Lei is currently experiencing chest tightness and upper abdominal pain. The electrocardiogram indicates an acute cardiac problem. The cardiology department is currently evaluating him, and he may require emergency interventional treatment. Please keep your phone accessible."

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

Then his voice trembled.

"Wasn't he on vacation? How could he have a heart attack?"

While looking at the electrocardiogram, Tang Zhendong said, "Don't ask why yet, ask if you can get here in time."

The woman immediately said, "I'm coming, I'm coming right away."

Qin Hai added a sentence.

"Don't hang up the phone while you're on the go. You may need to give informed consent via phone and have it recorded later."

The voice on the other end of the phone was choked with sobs.

"well."

Jiang Lei heard his wife's voice and scratched at the bed sheet with his fingers.

"Don't tell my mom..."

Nurse Zhao placed the medicine cup beside the bed.

"Take care of yourself first."

After reviewing the patient's medical history and contraindications, Tang Zhendong looked down at Qin Hai.

"Administer antiplatelet therapy first. Notify the catheterization lab and prepare according to the emergency coronary intervention procedure. Be alert for right ventricular involvement in the inferior wall. Do not use nitrates indiscriminately, and keep a close eye on blood pressure."

Qin Hai nodded.

"Record."

Lin Ye wrote down the time.

One fifty-eight.

Jiang Lei, a patient with chest tightness and upper abdominal pain, underwent a follow-up electrocardiogram showing dynamic changes.

The cardiology department was present.

Acute coronary syndrome is highly suspected.

Emergency intervention procedure preparation.

Inform the family members by phone.

The system countdown jumped to six minutes and forty-two seconds.

It's not a cancellation.

It only suppressed a little.

Over there, Yuan Guilan's blood pressure was still hovering around 80.

Nurse Zhao glanced over at it.

"Yuan Guilan's blood pressure was still low after receiving intravenous fluids."

Qin Hai didn't leave Jiang Lei's bedside, but simply asked, "How much urine?"

"I haven't peed yet."

Xu Mingzhe from the Department of Infectious Diseases and the on-call doctor from the Department of Gastroenterology entered the room almost one after the other.

Xu Mingzhe looked around and started by looking at the whiteboard.

"Thirteen patients have been diagnosed? Do they have fever or bloody stools?"

Sun Zhiqiang answered quickly.

"There is no blood in the stool yet, but both have low-grade fever, vomiting, and diarrhea. They shared boxed meals at the service area, and a lot of the cold dishes were exposed, but the list hasn't been finalized yet."

A gastroenterologist visits Yuan Guilan.

"The elderly patient has significant hypovolemia. Immediately administer fluids and correct electrolyte imbalances. If necessary, assess for hospitalization. Don't rush to stop diarrhea and pressure symptoms; first assess the degree of infection and dehydration."

Liang Xiulan also arrived.

She went straight to the children as soon as she entered the door.

The child was curled up in bed, his eyelids heavy and his lips dry.

Liang Xiulan touched the child's hands and feet, and then checked the blood sugar and electrolytes.

"Low potassium, borderline blood sugar, continue fluid replacement, administer glucose and potassium at pediatric dosages, and monitor the heart rate. Do not allow family members to feed the child any more beverages."

The child's father became anxious.

"He keeps saying he's thirsty, can't he have some sports drinks?"

Liang Xiulan looked at him.

"With such vomiting, if you drink something and then vomit it up again, you might choke. Now, take supplements as prescribed by the doctor."

The emergency room was divided into several sections.

Jiang Lei's side, the cardiology department is preparing to send him to the catheterization lab.

The two elderly people received intravenous fluids, had their blood drawn, and had their urine output checked.

The child was taken in by the pediatric department.

The observation area continues to register fellow passengers.

The tour guide's seating chart was scribbled all over with red pen by Liu Zhenhua.

Each circle represents someone who might be overlooked.

Jiang Lei suddenly let out another muffled groan.

A series of short bursts of ventricular tachycardia appeared on the monitor.

Nurse Zhao's voice immediately rose.

"Short-range ventricular tachycardia!"

Tang Zhendong looked up.

"Apply the defibrillator patch and prepare emergency medication. The patient can't wait any longer; go directly to the catheterization lab."

Qin Hai is a tour guide.

"Keep the family members' phone numbers on, and have the tour guide fill in their identification information. Don't block the road."

The tour guide nodded so hard it looked like he was about to break his neck.

When Jiang Lei was pushed away, he still tried to grab his phone.

Nurse Zhao placed the phone next to him.

"Stop arresting me, my life is more valuable than my phone."

Jiang Lei's lips moved slightly.

This time, there was no rebuttal.

The flatbed cart is pushed toward the catheterization lab.

Tang Zhendong cursed as he walked.

"A heart attack could be hidden in a case of mass diarrhea. Your emergency room really knows how to wake people up from their slumber."

Qin Hai followed beside him.

"You woke up pretty quickly."

Tang Zhendong glared at him.

"If he had gone any slower, he wouldn't have gone to the catheterization lab, he would have gone to the emergency room for defibrillation."

Lin Ye ran a few steps after him and wrote the transfer time into the record.

2:04.

Jiang Lei was transferred to the catheterization lab for emergency evaluation due to a high suspicion of acute coronary syndrome, dynamic changes in his electrocardiogram, and short runs of ventricular tachycardia.

The system notification finally lit up briefly.

[High-risk individuals should not be allowed to enter the effective treatment process.]

[Final Night Current Progress: Under Evaluation.]

Lin Ye stopped at the entrance of the corridor, not even having time to catch his breath.

Nurse Zhao called for him from inside the emergency room.

"Lin Ye, Yuan Guilan's blood pressure has gone up a bit!"

He turned around.

Yuan Guilan's blood pressure rose from 82.50 to 92.58.

The old man's lips were still dry, but his eyesight was a little clearer than when he first came in.

"water……"

This time, the gastroenterologist nodded.

"Give small amounts of oral rehydration salts only if the patient can swallow them. Continue intravenous rehydration; do not force-feed all at once."

Regarding the child, Liang Xiulan said, "He's in a slightly better mood than before, but we still need to keep an eye on his potassium levels."

Several figures are shifting in a positive direction.

But none of them were reassuring enough.

Qin Hai returned to the nurses' station and looked at the unfinished final night note on the wall.

Lin Ye picked up his pen and added the second line.

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.

Don't do anything yet: Don't assume it's just an upset stomach, and don't overlook people who have chest tightness and sweating but don't have diarrhea.

Who to call: Infectious Diseases Department, Gastroenterology Department, Pediatrics Department; Chest tightness and upper abdominal pain are called Cardiology Department alone.

After looking at them, Nurse Zhao said in a low voice, "This one is the most tiring."

Lin Ye nodded.

"Because there are many people."

Qin Hai looked at the row of vomit bags in the observation area.

"no."

He clipped Jiang Lei's electrocardiogram into the medical record.

"Because the truly deadly ones love to hide in crowded places."

No sooner had he said that than the tour guide looked up from the triage desk.

"Director Qin, the list doesn't match."

Liu Zhenhua's expression changed.

"Who's missing?"

The tour guide looked at the seating chart, his voice weak.

"There was an old man in the last row, surnamed Gu. Everyone thought he was asleep, so he didn't get off the bus."

The emergency room lobby fell silent for a moment.

Lin Ye looked towards the door.

The gray cursor on the system interface blinked.

[Final risk of not being able to triage overnight: To be confirmed.]

The early morning wind blew in through the door.

The service area bus hadn't even delivered everyone to them yet.