Condition	Assessment: Signs and Symptoms	Prehospitalization Nursing Care	In-hospital Nursing Care
	Severe or late shock Sensorium: confused, disoriented, apathetic, unresponsive; slow, slurred speech, often incoherent Pupils: dilating, dilated, slow or nonreactive to light Pulse: rate >150 beats/min, thready, weak Blood pressure: 80 mm Hg or unobtainable Neck veins: flat in a supine position - no filling; full to distended inseptic or cardiogenic shock Skin: cold, clammy, mottled; circumoral cyanosis, dusky, cyanotic Eyes: sunken - vacant expression Renal: urine output <20 mL/hr	Raise feet 6-8 inches unless patient has head or chest injuries; if victim becomes less comfortable, lower feet If patient complains of thirst, do not give fluids unless you are more than 6 hour away from professional medical help; under no conditions give water to patients who are unconscious, having seizures or vomiting, appearing to need general anesthetic, or with a stomach, chest, or skull injury Be calm and confident; reassure patient help is on the way	Assess and intervene as for early shock; then obtain information as to onset and past history Catheterize and monitor patient urine output as ordered Take 12-lead ECG Insert nasogastric tube and assess aspirate for volume, color, and blood; save specimen if poison or drug overdose suspected If CVP low - infuse 200-300 mL over 5-10 min If CVP rises sharply, fluid restriction necessary; if remains low, hypovolemia present If patient febrile - blood cultures and wound cultures will be ordered if urine output scanty or absent - give mannitol as ordered
Respiratory Emergencies
Choking - obstruction of airway secondary to aspiration of a foreign object	Gasping, wheezing; looks panicky, but can still breathe, talk, cough Cough: weak, ineffective; breathing sounds like high-pitched crowing; color - white, gray, blue Difficulty speaking; clutches throat	Do not interfere if coughing; do not slap on back; watch closely; call for assistance Victim standing, sitting and conscious: Perform obstructive airway maneuver (formally Heimlich maneuver), stand behind victim, wrap arms around waist, place fist against abdomen, and with your other hand, press it into the victim’s abdomen with a quick upward thrust until the obstruction is relieved or the victim becomes unconscious	As in prehospital care
		Victim lying down: Roll the victim onto his or her back; straddle the victim’s thighs; place heel of hand in the middle of abdomen; place other hand on top of the first; stiffen arms and deliver 6-10 abdominal thrusts	As in prehospital care

Condition

Assessment: Signs and Symptoms

Prehospitalization Nursing Care

In-hospital Nursing Care

Severe or late shock

Sensorium:

confused, disoriented, apathetic, unresponsive; slow, slurred speech, often incoherent

Pupils:

dilating, dilated, slow or nonreactive to light

Pulse:

rate >150 beats/min, thready, weak

Blood pressure:

80 mm Hg or unobtainable

Neck veins:

flat in a supine position - no filling; full to distended inseptic

cardiogenic shock

Skin:

cold, clammy, mottled; circumoral cyanosis, dusky, cyanotic

Eyes:

sunken - vacant expression

Renal:

urine output <20 mL/hr

Raise feet 6-8 inches unless patient has head or chest injuries; if victim becomes less comfortable, lower feet
If patient complains of thirst, do not give fluids unless you are more than 6 hour away from professional medical help; under no conditions give water to patients who are unconscious, having seizures or vomiting, appearing to need general anesthetic, or with a stomach, chest, or skull injury
Be calm and confident; reassure patient help is on the way

Assess and intervene as for early shock; then obtain information as to onset and past history
Catheterize and monitor patient urine output as ordered
Take 12-lead ECG
Insert nasogastric tube and assess aspirate for volume, color, and blood; save specimen if poison or drug overdose suspected
If CVP low - infuse 200-300 mL over 5-10 min
If CVP rises sharply, fluid restriction necessary; if remains low, hypovolemia present
If patient febrile - blood cultures and wound cultures will be ordered
if urine output scanty or absent - give mannitol as ordered

Respiratory Emergencies

Choking - obstruction of airway secondary to aspiration of a foreign object

Gasping, wheezing; looks panicky, but can still breathe, talk, cough

Cough: weak, ineffective; breathing sounds like high-pitched crowing; color - white, gray, blue

Difficulty speaking; clutches throat

Do not interfere if coughing; do not slap on back; watch closely; call for assistance

Victim standing, sitting and conscious:

Perform

obstructive airway maneuver

(formally Heimlich maneuver), stand behind victim, wrap arms around waist, place fist against abdomen, and with your other hand, press it into the victim’s abdomen with a quick upward thrust until the obstruction is relieved or the victim becomes unconscious

As in prehospital care

Victim lying down:
Roll the victim onto his or her back; straddle the victim’s thighs; place heel of hand in the middle of abdomen; place other hand on top of the first; stiffen arms and deliver 6-10 abdominal thrusts

As in prehospital care