Of blown pupils and brain waves - page 3

A friend across the country called me the other day and her dad apparently had a massive MI. He called out, she found him on the floor. He was subsequently Coded, given bicarb (sounds like it... Read More

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    Thanks for the information, NeuroICURN. My unit doesn't use vents or propofol, which is why I was clueless in this case.

    Nevertheless, your information is helpful to me because we are a stroke unit, and who knows? I find that information that I get here comes in handy at some point.

    The family is having a simple memorial service today, which is what he would've wanted.

    Again, thanks for all of your thoughts and prayers to this family in their time of loss.

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    With anoxic brain injury there are a couple of non-neurologic findings that if present make EEG's and brain death tests moot. One is "Box cars" on the retina - areas of small anoxic injury - these are almost invariably mirrored on the brain and indicated global ischaemia.

    The other is the diarrhoea - that is distinctive. It come from ischaemic gut. Obviously if the gut has signs of ischaemia then the brain which requires a higher oxygen demand will have suffered more.

    Sometimes the brain death tests are not done straight away because intially the patient will not fit the criteria but as time goes on and the areas of the brain that suffered ischaemia swell then with the rising ICP there is more damage until death ensures.

    Sorry for your freinds Dad.
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    Quote from NeuroICURN
    As a neuro nurse, I have a real problem with some of the statements made in your posting.

    Blown pupils can mean brain death, but don't always.....so, please don't ever make a statement like that again. There's WAY MORE to brain death criteria than just blown pupils. Also, an EEG is not always part of the criteria, but it can be one of the tests done.

    Ok, yes you were correct with the head CT being done for any neurological changes noted. However, we don't hyperventilate anymore....this is only a very short term fix, but usually causes MORE of a problem later. Anyway, as for the CT....without getting into great detail here, it can tell you some things, but not others. It can identify if he has any bleeding, perhaps from the fall, it can show a stroke from a clot....but it takes 2-3 days for that to show up. A CTA can be done to visualize the vasculature.

    As for sedation for a vented pt., propofol (Diprivan) is the most commonly used one. Propofol tends to make pupils pinpoint and difficult to assess. Thankfully though, it only has a half-life of approx. five to ten minutes, so assessment can be done pretty quickly. But yes, if someone has a blown pupil even while sedated on propofol, then there is a problem.

    Other than hyperventilation being old fashioned, however, you didnt really say anything new. And what less ominous condition can blown pupils indicate? (before you answer, i mean bilateral fixed and dilated pupils.)
    Last edit by Nurse Ratched on Nov 7, '04
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    I have seen blown pupils in dilantin (Phenytoin) overdose and the patient recovered!!!! The only time (almost) I have seen fixed dilated pupils that subsequently walked out the door.

    It can also simply signify a III nerve lesion.
  5. 0
    Generally sedated patients have smaller pupils because of the effects of benzos or whatever they are on. Dilated pupils are never a good sign because cranial nerves are unforgiving especially after cardiac arrest. best wishes.

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