Assessing pupil size - Sounds simple, but...
- 0Dec 9, '11 by in2ICUI have worked at two equally well recognized teaching hospitals in an ICU setting. Most everything is the same, but I've noticed a difference in how pupil size is assessed.
Hosp#1 - Assess size of pupil as it reacts to pen light so as to eliminate variation in room lighting.
Hosp#2 - Assess size of pupil upon initial inspection, regardless of room lighting, etc. (and before using pen light).
I do look at the pt's pupils initially, but I make my measurement based on the size to which they constrict.
So I am wondering - how does everyone else do it?
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- 0Dec 9, '11 by in2ICUIn response to the above replies:
But how do you standardize on "regular lighting"? Day vs night, different light switches (we have about 8 lighting options in each room - it's ridiculous), if pt's eyes were open or closed prior to exam?
That's what I'm getting at. If we report the size upon initial inspection that can be incredibly variable based on external factors. Do your units have a standard set for this? I know mine doesn't and the results are all over the place.
I don't have any issues with the reactivity and regularity... it's just a specific question of timing that pupil size is measured.
- 0Dec 10, '11 by Esme12 Senior ModeratorYou are over thinking the issue. If you are checking the pupils at 0800 the "norm" is that it is daylight. YOu look at the pupils in ambient light comparing size and shape. Are the irregular in size? are they unequal? Do they both react equally and at the same time to light?(accommodation). Pupillary response changes can be, and usually is, a late sign of increasing intracranial pressure and there should be other more subtle signs of increasing pressure such as confusion and lethargy or agitation. The checking of pupils is obtaining a baseline and reporting changes. People who have had cataract surgery will not have much of a pupillary response and there is an anomaly the can be normal, anisocoria.
Get a base line, look for differences.....the subtle changes due to time of day are understood.