Page 7 of Twin Surprise for the Italian Doc

‘Is it the first time you’ve experienced it?’

‘Yes.’

‘How bad is it? On a scale of zero to ten, with zero being no pain at all and ten being the worst you can imagine?’

‘Ten...’ He groaned again. ‘And I feel sick...’

‘We’ll give you something to help with that in just a minute.’

Matteo held a tympanic thermometer close to their patient’s ear.

‘Temperature’s normal,’ the nearest judgeinformed him as he continued taking baseline recordings. ‘He’s tachycardic at one-twenty, respirations are twenty-four and his blood pressure is one-thirty over ninety.’

Matteo caught Luke’s glance. With a normal temperature, infection was less likely to be a cause of this pain so a diagnosis like appendicitis or diverticulitis could be ruled out for the moment. What was needed now was pain relief.He collected everything he needed to insert an IV line and put a tourniquet on the man’s arm.

‘The IV line is in.’ The judge nodded.

‘Have you had any trouble urinating?’ Luke asked now. ‘Is it painful or have you noticed anything different?’

‘It hurts,’ the man replied. ‘And it’s very dark.’

Luke glanced at Matteo, who nodded. The diagnosis and their management now appeared simple.

‘We thinkyou might have a kidney stone,’ Luke said. ‘And it’s blocking your ureter and causing this pain. We’ll give you something for the pain and then we’ll take you to hospital. Are you allergic to anything that you know of?’

‘No.’

Matteo was already going through the motions of drawing up the morphine.

‘What dosage are you administering?’ one of the judges asked.

‘We’ll start with five milligrams,’Luke replied. ‘We can top that up if the pain scale isn’t reduced to less than five.’

The judge nodded. ‘The drug has been administered.’

Matteo began tidying up and Luke was checking their briefing sheet that gave a list of available hospitals and means of transport. They needed to choose the most appropriate option, which ranged from leaving the patient where he was, transport by helicopteror ambulance to the nearest general hospital, a higher-level hospital or a specialised centre.

Matteo dropped the packages of IV gear back into his pack and turned to pick up the blood-pressure cuff.

To his horror, he could see that their patient now seemed to be having trouble breathing and he was clutching at his chest.

‘Luke...’ The word was a warning. He reached out to take the man’s pulse.‘Do you have chest pain, sir?’

Their patient didn’t respond. His head fell back against the pillow and he was gasping for breath.

Luke was still processing this unexpected twist in their scenario.

‘Do we see any skin changes?’

‘You see redness appearing,’ a judge said. ‘And hives.’

Nothing more than a glance between Luke and Matteo was needed.

‘Anaphylaxis to morphine,’ Matteo agreed quietly.‘I’ll get a bag of fluids up. And we need some adrenaline, stat.’

They both worked swiftly to counter a potentially fatal situation, administering drugs, getting their patient on oxygen and a cardiac monitor. Within a couple of minutes the judges were nodding with satisfaction and declared the scenario complete. They just wanted to ask some questions.

‘What is your hospital of choice for thispatient?’

---