TABLE 7-46 Nursing Care of the Adult in Medical and Surgical Emergencies - continued

Condition	Assessment: Signs and Symptoms	Prehospitalization Nursing Care	In-hospital Nursing Care
		On shore: Check breathing Lay victim flat on back; cover and keep warm Calm and reassure victim Do not give food or Get to medical assistance as soon as possible If unconscious and not breathing: begin sequence for CPR; compress water from abdomen only if interfering with ventilation If airway obstructed: reposition head; attempt to ventilate; if EMS responder: perform 6-10 abdominal thrusts; sweep mouth deeply; attempt to ventilate; repeat until successful Once ventilation established, check pulse; if absent, begin chest compressions as in CPR, one-person or two-person rescue Continue CPR until victim revives or help arrives If victim revives, cover and keep warm reassure victim help is on the way Rescue personnel can further assist emergency department personnel by: Documenting prehospital resuscitation methods used Immobilizing victims suspected of cervical spine injuries Using a sterile container to take a sample of immersion fluid Taking on-scene arterial blood gas sample for later analysis	Symptomatic near-drowning victim Provide basic or advanced Provide clear airway and adequate ventilation by: Suctioning airway Inserting artificial airway and attaching it to ventilator as indicated Inserting nasogastric tube to suction to minimize aspiration of vomitus Monitor ECG continuously Start IV infusion 5% D/W at keep-open rate for fresh water near-drowning; 5% D/NS in salt water near-drowning Assist with insertion of CVP and Swan-Ganz catheter to guide subsequent infusion rates Administer drugs as ordered: anticonvulsants; steroids, antibiotics, stimulants, antiarrhythmics Provide rewarming if hypothermia present Insert Foley to assess kidney function because fresh water near-drowning causes renal tubular necrosis due to RBC hemolysis Transfer to ICU when stabilized