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

As soon as Nurse Zhao finished speaking, the automatic door at the emergency room entrance opened again.

The morning light streamed in through the glass door.

A man stood there, leaning against the door frame.

He was around thirty years old, tall and thin, and his black jacket was not zipped up properly, revealing a white T-shirt underneath that was sticking to his chest with sweat.

He wasn't carried in.

It wasn't brought here by a flatbed cart.

He walked in by himself.

But with each step, his shoulder would slump to the left.

It feels like there's a thread in my chest being pulled down.

"Chest pain?"

The triage nurse has already stood up.

The man nodded.

The lips are pale.

"left."

After he finished speaking, he placed his hand on his left chest.

The fingers are very thin, and the knuckles turn blue from exertion.

Nurse Zhao came out from behind the nurses' station.

"How long has it been?"

"More than half an hour."

The man took a breath.

He only managed to inhale halfway before the pain cut him off.

He bent down, supporting his knee with his other hand.

"It feels like being pricked with needles, and I can't breathe."

A young woman in a hoodie caught up with us, holding a phone and a registration slip in her hand.

The registration slip was soaked with sweat and the edges were curled up.

The name field reads: Shen Qingyuan, 31 years old.

"He woke up in the morning complaining of chest pain, and I thought he had a stitch in his side."

Her voice was very fast.

"He even went downstairs by himself, so I thought it probably wasn't serious."

Qin Hai had just returned from the direction of the CT room, his shoes making a series of rapid sounds on the ground.

He didn't stop walking when he heard the words "chest pain".

"Career position".

Nurse Zhao has already gone to push the wheelchair.

The man waved his hand.

"No need, I can walk."

Qin Hai glanced at him.

Being able to walk doesn't mean you can wait.

The front wheelchair rolled over the gray water stain at the doorway with a soft thud.

The man was about to speak when, a second later, his shoulder swayed.

Nurse Zhao caught him.

"sit down."

This time, the man didn't try to hold on.

When he sat in the wheelchair, it was as if a part of his strength had been drained away. His back was pressed against the back of the chair, and his chest was rising and falling rapidly.

Lin Ye had just handed Xu Jianmin's transfer slip to Sun Zhiqiang when he heard the noise and turned around.

My gaze first fell on the man's face.

His face was pale.

Cold sweat beaded on my forehead.

Breathing is shallow and rapid.

It's not like a normal side stitch.

The triage nurse wrapped the cuff around her arm.

The Velcro made a ripping sound when it was torn open.

Blood pressure 132/84.

Heart rate 126.

Blood oxygen 93.

Body temperature is normal.

Nurse Zhao re-clamped the pulse oximeter.

The waveform is unstable.

Ninety-two.

Ninety-one.

She looked up.

"Blood oxygen levels are dropping."

The man's girlfriend's face also turned pale.

"Didn't you have chest pain? Why are you on oxygen?"

No one answered her first.

Qin Hai pushed the wheelchair towards the monitoring position.

"Oxygen. Electrocardiogram. Blood test: complete blood count, troponin, D-dimer, electrolytes, blood gas analysis. Don't let him lie flat yet, keep him in a semi-recumbent position."

Nurse Zhao connected the oxygen tube, pulling the plastic tube out of its packaging, making a soft, rustling sound as she rubbed it.

Even after the man inhaled oxygen, his chest still heaved rapidly.

Lin Ye stood by the bed.

"How did the pain begin?"

The man closed his eyes.

"I was just brushing my teeth when suddenly..."

"Do you have back pain?"

"no."

"Did you feel a tearing sensation?"

The man shook his head.

The movements were very small.

"It's in the left chest area, puncture it."

"Do you have a cough? Do you have a fever?"

"no."

"Recent injury? Collision? Strenuous exercise?"

His girlfriend chimed in, "He played basketball last night, and when he came back he said his shoulders were a little sore."

The man frowned.

"It wasn't from hitting the ball."

He says one sentence, then pauses.

"My teeth suddenly started hurting when I was brushing them this morning."

Lin Ye didn't answer "Is that right?"

He put the stethoscope into his ear.

The rubber tube was a little cool, and when it was placed against the man's chest, his shoulder twitched.

Right.

Breathing sounds can be heard.

left.

Clearly weak.

Lin Ye paused for a second, then moved his armpit down.

It's still weak.

He looked up.

"Decreased breath sounds on the left side."

Qin Hai was receiving the first electrocardiogram chart.

The paper was still hot, and the edges slowly emerged from the machine's nozzle.

He glanced at it.

"There is no obvious ST segment elevation."

Sun Zhiqiang happened to walk to the bedside and heard this, and his brows relaxed halfway.

Lin Ye took off his stethoscope.

"But his blood oxygen levels dropped, his breath sounds were low on the left side, and he suddenly experienced chest pain."

Sun Zhiqiang swallowed his last breath.

"pneumothorax?"

Qin Hai didn't look up.

"Check in this direction first, don't just focus on the electrocardiogram."

The man's girlfriend was stunned.

"Pneumothorax? The kind where there's air leaking from the lungs?"

She looked down at her boyfriend.

"But he walked in by himself."

Nurse Zhao wrapped the monitoring cable around the man's coat sleeve.

"We've seen plenty of patients walk in on their own."

She pressed the electrode pads onto the man's chest.

"Just because you've come in doesn't mean everything's alright."

When the electrode pads are applied to sweaty skin, the edges curl up slightly.

Nurse Zhao pressed down with her finger, and the adhesive was finally reattached.

The man's breathing became shallower and shallower.

"I'm a little...out of breath."

His voice softened.

It's not about being coquettish.

There's really not enough energy.

Lin Ye's vision suddenly flashed.

A light blue border popped up next to the monitor.

[High-risk warning: Sudden chest pain accompanied by progressive hypoxia.]

[Suspected diagnosis: Left-sided spontaneous pneumothorax, with a risk of tension progression.]

[Current risk: Deterioration of respiratory and circulatory function.]

[Recommendation: Based on physical examination and verification of vital signs.]

Lin Ye's fingers tightened around the edge of the medical record folder.

That prompt only gave directions.

What can truly get everyone moving are these things by the bedside.

Blood oxygen.

Breath sounds.

Nature of chest pain.

The rise and fall of the chest in front of me is getting shallower and shallower.

Bedside ultrasound.

Qin Hai has already given the order.

"Chest X-rays are also called that, but don't wait for the X-ray before making any moves."

Sun Zhiqiang pushed the ultrasound machine over to the bedside.

The machine wheel got stuck on an IV patch on the ground.

He ducked down, stepped on the edge of the sticker, and shoved the machine forward.

When the screen lit up, you could see several people's bloodshot eyes reflected in the light.

Qin Hai placed the probe on the man's left chest.

A clump of coupling agent was squeezed out, and the man gasped from the cold.

"Don't hold your breath, breathe however you can."

Qin Hai stared at the screen.

The probe slid to the right.

You can also see the pleural line sliding on the screen.

Switch to the left side.

He paused for a moment.

Sun Zhiqiang also moved closer.

"Left-side slip difference".

Lin Ye looked at the man's neck.

The jugular veins were not noticeably distended.

My blood pressure is still holding up.

But my heart rate jumped up again.

One hundred and thirty-two.

Blood oxygen 89.

The monitor alarm went off in a high-pitched voice.

drop.

drop.

Drop drop drop.

The girlfriend was so startled by the sound that she took a step back, her calf hitting the foot of the bed.

The metal edge of the bed leg made a dull thud.

"Why did it fall again?"

Nurse Zhao increased the oxygen flow rate.

"Don't stand around the bed, take half a step back."

After she finished speaking, she looked at the man again.

"Don't say anything, save your breath."

The man wanted to nod.

I only ordered half of it.

The thoracic surgery hotline was then connected.

Sun Zhiqiang pressed the speakerphone button.

The person on the other end of the phone had just woken up; their voice was hoarse.

"Emergency room?"

Qin Hai reported it directly.

"A 31-year-old male presented with sudden onset of left-sided chest pain and shortness of breath. His oxygen saturation dropped from 93 to 89, and breath sounds on the left side were significantly diminished. Bedside ultrasound revealed poor lung mobilization on the left side. Spontaneous pneumothorax on the left side is suspected. Chest X-ray is pending, and the patient's symptoms are progressively worsening."

There was a two-second pause on the other end of the phone.

The sound of blankets rubbing together came from the other side.

"I'm going down."

Qin Hai added a sentence.

"If your blood pressure drops, your trachea deviates, or your breathing continues to worsen, the emergency room will handle it first."

"Can."

The thoracic surgeon's voice became a little clearer.

"Prepare the puncture and closed drainage kits first, I'll be there soon."

When his girlfriend heard the words "puncture" and "drainage," she froze.

"Do you need surgery?"

The man also opened his eyes and looked at Qin Hai.

Qin Hai didn't make his statement completely.

"First, determine the extent of the air leak and whether it's compressing the heart and lungs. For minor leaks, oxygen can be administered and observation continued; for severe leaks, the air needs to be released."

He pointed to the monitor.

"His oxygen levels are dropping, so we can't just give him a gentle treatment."

The girlfriend bit her lip.

She bit off a piece of her lipstick, leaving a smear of color on her lips.

"I'll sign."

Qin Hai looked at the hospital bed.

"He's lucid; ask him first."

The man was breathing oxygen, his chest rising and falling rhythmically.

"Treat it if it can be cured."

He paused.

"Don't let my parents know."

My girlfriend's eyes immediately welled up with tears.

"What time is it?"

The man didn't look at her.

His gaze was fixed on the lamp above his head.

The edge of the lampshade was covered in dust, making it appear slightly yellow when the light shone on it.

My mom has a heart condition.

Qin Hai clipped the notification slip onto the medical record board.

The paper clip snapped shut with a click.

"It's not a question of whether or not to keep it a secret now."

He lowered his voice.

"You can sign, but we need to contact someone if your condition changes. We'll focus on treatment first, and contact your family simultaneously. We'll explain what to say over the phone."

The man closed his eyes.

This time, there was no further rebuttal.

When the mobile X-ray imaging technician pushed the bedside X-ray machine in, a narrow path had already been cleared next to the monitoring station.

The machine wheels rolled over the disposable glove packaging on the ground, and the plastic bag was crushed with a snap.

"Inhale."

The cameraman had barely finished speaking when he saw the man's appearance again and immediately changed his story.

"Inhale as much as you can, don't force yourself to hold it in."

When the board was shoved behind the man's back, he gripped the sheets tightly with his fingertips in pain.

The bed sheet was crumpled into several wrinkles.

Click.

A soft sound.

The images came out very quickly.

On the screen, a large area of ​​the outer side of the left lung field was transparent, the lung markings disappeared, and the lung tissue was pressed towards the hilum.

Qin Hai glanced at it once, and his brow furrowed.

"Left-sided pneumothorax, quite substantial."

Sun Zhiqiang zoomed in on the film.

"There is no obvious shift in the mediastinum at present."

As soon as he finished speaking, the man suddenly coughed.

It's very light.

But it was as if he had coughed away the last bit of air in his chest.

Blood oxygen 87.

Heart rate 140.

My blood pressure dropped from 132/84 to 104/70.

Lin Ye stared at the numbers.

"It's moving in the direction of tension."

Qin Hai had already reached out.

"Prepare for left thoracentesis to decompress the pleural cavity. Save the patient's life before the thoracic surgeons arrive. Sun Zhiqiang, record the time. Nurse Zhao, prepare lidocaine, thoracentesis kit, and closed drainage kit."

Nurse Zhao turned around and opened the drawer of the emergency cart.

The metal drawer slides made a series of piercing noises.

She muttered a curse as she picked up her things.

"They don't even let people catch their first breath in the morning."

No one laughed.

The man's girlfriend stood at the foot of the bed, her phone screen lit up.

The number above is labeled "Auntie".

Her finger hovered over the dial key, trembling so much she couldn't press it.

Lin Ye glanced at it.

"Attack first."

The girlfriend looked up.

"I don't know how to say it."

Lin Ye shifted his gaze away from the monitor.

"Tell him he's in the hospital, and the doctor is dealing with the air in his chest. Don't say he's about to die, but don't say he's fine either."

Her throat moved.

Finally, I pressed it.

The phone kept ringing as it connected.

Qin Hai had already put on sterile gloves.

The glove snapped back onto my wrist with a snap.

He looked at the man.

"Now you need to let out some air. It will hurt, but if you don't let out, you'll have even more trouble breathing."

The man's eyes were open.

Cold sweat trickled down his forehead, down his temples, and down to his ears.

"put."

One word.

It squeezed out from between his teeth.

Sun Zhiqiang looked down and kept track of the time.

6:12 AM.

Left-sided chest pain, shortness of breath, and worsening hypoxia.

Bedside ultrasound showed a slip differential in the left lung.

The moving chest X-ray revealed a large pneumothorax on the left side.

Blood pressure drops, heart rate increases.

Qin Hai's finger landed on the positioning point.

As the disinfectant cotton ball was wiped across the skin, the smell of iodine immediately filled the air.

The man's chest muscles were taut.

Nurse Zhao pressed down on his shoulder.

"Don't hide."

The call was finally answered.

My girlfriend's voice suddenly changed tone.

"Auntie, please don't panic. He's in the emergency room at the First Municipal Hospital, and the doctors are treating him..."

She started crying halfway through her sentence.

Qin Hai did not turn around.

The man groaned the moment the needle entered.

next second.

A hissing sound came out from the end of the needle.

hiss--

It's very light.

But it made everyone around the bed relax a little.

Blood oxygen levels jumped from 87 to 89.

ninety.

Ninety-two.

My heart rate is also fast.

But that downward momentum stopped.

Lin Ye looked at the monitor.

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

[Current Status Update: The left-sided spontaneous pneumothorax with increasing tension has been moved to the emergency treatment protocol.]

[Result: Further closed drainage and monitoring by thoracic surgeons are still required.]

Further evaluation is still needed.

It's not a one-shot deal.

Lin Ye withdrew his gaze.

The footsteps of the thoracic surgeon could be heard coming from the end of the corridor.

He ran up and his white coat was flipped up, and he was still carrying an unclosed equipment bag in his hand.

The first thing he saw when he entered the room was the monitor.

The second thing to look at is the chest X-ray.

The third thing I noticed was the puncture needle in Qin Hai's hand.

"Left side?"

Qin Hai nodded.

"The decompression has just been relieved and the oxygen level has risen. Prepare for closed drainage."

The thoracic surgeon placed the instrument pack on the bedside treatment cart.

The zipper wasn't fully zipped up, and a corner of the sterile package inside was sticking out.

Have you contacted the family?

My girlfriend was holding up her phone, tears still streaming down her face.

"His mother is online."

The thoracic surgeon took the phone and walked to a spot half a step away from the bed.

"Hello, I'm a thoracic surgeon. Shen Qingyuan currently has a left-sided pneumothorax. He's already experiencing hypoxia and a drop in blood pressure. We've performed decompression in the emergency room, and next we need to perform closed chest drainage to continuously remove the leaking air..."

He spoke very quickly.

But every sentence focused on the patient's condition.

The man lay on the bed, his eyes half-open.

My chest still hurts.

I was finally able to inhale a little deeper.

Nurse Zhao straightened the oxygen tube and casually removed the registration slip, which was soaked with sweat, from the edge of the bed.

The back of the registration slip reads "Regular Outpatient Clinic".

She glanced at it and tossed it into the transparent bag next to the medical record folder.

"Long queues at regular outpatient clinics?"

Her voice was very low.

"If we wait another ten minutes, people will run out of breath."

Qin Hai took off one glove, revealing a ring of yellow iodine stain on his wrist.

He looked at Lin Ye.

"remember."

Lin Ye looked up.

Qin Hai pointed to the man who was just able to catch his breath.

"Chest pain isn't just about the heart. You might be able to walk in, but you could also give up in the next minute."

Lin Ye nodded.

Outside in the corridor, a new round of numbers was called out.

At the same time, Xu Jianmin's interventional room also called the nurses' station.

As soon as Nurse Zhao answered the call, her expression, which hadn't fully relaxed, tensed up again.

"Director Qin."

She covered the receiver.

"The interventional radiology department said the blood clot was longer than it appeared on the scan."