patients eyes moving back and forth horizontally... dying?

  1. 1
    Had a new admission today - pt was a full code, supposed to go to step down unit. But came to our med surg today after she was stabilized on 100% face mask (aspiration). She got up to the unit right at shift change. Pulse ox was 97-100% when she first got up there. THen went into respiratory distress when the day shift nurse and CNA were in the room - pulse ox went down to 66% at the lowest. rapid response was called and they gave her Lasix, suctioned multiple times (bloody?!), ABGs, etc. (BTW this patient is from a nursing home, + MRSA, contractures, G-tube, colostomy, completely aphasic, eyes are open but pt is nonresponsive at baseline, the works).

    They finally got a hold of the Dr who talked to the family (who hrs earlier wanted her to be intubated) and made her comfort care. (The critical care nurse who was talkign to MD on the phone mentioned the Dr wouldn't give a morphine drip order). Another dr who was on the unit came in and mentioned her eyes were moving back and forth horizontally and the day shift nurse asked a critical care nurse what he meant by that and the CC nurse said it means she's dying. Is this true? What makes this happen?
    NREMT-P/RN likes this.
  2. 13 Comments so far...

  3. 2
    There are many different causes of nystagmus.
    Altra and NREMT-P/RN like this.
  4. 0
    Without - Actually being there -

    I will suspect that maybe a "Doll's Eye's" reflex is present.

    It is a bit creepy the first time (heck, anytime) you see it. It is usually indicative of catastrophic brain stem issues.

    I think that you had a difficult situation.

    I may not always KNOW what is right - but I rarely have problems determining what is KIND. NOT euthanasia - so, hold it folks - but, compassionate care.

    Practice SAFE!


    Sounds like you did the BEST you could.
  5. 3
    Quote from NREMT-P/RN
    Without - Actually being there -

    I will suspect that maybe a "Doll's Eye's" reflex is present.

    It is a bit creepy the first time (heck, anytime) you see it. It is usually indicative of catastrophic brain stem issues.

    I think that you had a difficult situation.

    I may not always KNOW what is right - but I rarely have problems determining what is KIND. NOT euthanasia - so, hold it folks - but, compassionate care.

    Practice SAFE!

    Sounds like you did the BEST you could.
    They call it "comfort measures" but it is really euthanasia. They start in with the morphine and keep giving a little more and a little more and a little more. I don't think this is wrong and I hope I'm treated so mercifully, I just wish we could call it what it really is.
  6. 3
    Quote from GoLytely
    They call it "comfort measures" but it is really euthanasia. They start in with the morphine and keep giving a little more and a little more and a little more. I don't think this is wrong and I hope I'm treated so mercifully, I just wish we could call it what it really is.
    Somehow, I think that ANY possibility of JAIL or PRISON would keep us from using a correct or "kind" terminology.

    I agree with you however.

    Better to go out in the humane arms of "morpheus" in an kind and manner consistent with "compassionate care" than to leave this earth struggling in all types of agony.

    NO I am not "playing God" - just being a NURSE - one that values dignity and quality of life.

    IMHO -

    Practice KINDLY and SAFE!
    Jo Dirt, skittlebear, and HappyPediRN like this.
  7. 0
  8. 0
    Interesting and GREAT ethical discussion.

    I have done things to patients in the interest of "legal" issues that may land in me in H*%% - but, as I believe in a compassionate God - I'll pray for forgiveness and mercy.

    However, I suspect that MANY other "healthcare folks" will be in the same spot of "judgement".

    Practice SAFE!
  9. 0
    Nystagmus can also be caused by certain medications and medical conditions. I had an albino client in a long term facility and nystagmus was her baseline. Was it something acute in this patient?
  10. 3
    Quote from NREMT-P/RN
    Without - Actually being there -

    I will suspect that maybe a "Doll's Eye's" reflex is present.

    It is a bit creepy the first time (heck, anytime) you see it. It is usually indicative of catastrophic brain stem issues.

    I think that you had a difficult situation.

    I may not always KNOW what is right - but I rarely have problems determining what is KIND. NOT euthanasia - so, hold it folks - but, compassionate care.

    Practice SAFE!


    Sounds like you did the BEST you could.
    This IS usually an indication of brain stem damage, but it isn't the Doll's Eye reflex. The Doll's Eye reflex is a normal finding. If you hold a patient's eyes open, then turn the head, the eyes will stay pointed in their original direction briefly. (So if the eyes are pointed at the ceiling, and I turn their head, the eyes will stay pointed at the ceiling at first.) The absence of this reflex (meaning if I turn their head, the eyes come with it) is, to use the medical term, really, really bad.
    Pedi-Gree, skittlebear, and nrsang97 like this.
  11. 0
    Nystagmus can be caused by many things: Ocular Albinism which is a lack of pigment in the retna that albino's have. You can also have ocular albinism with normally pigmented skin/hair/irises.

    Brain injury, various kinds, can cause nystagmus.

    Medications, especially those used for anesthesia ie: Ketamine, can cause nystagmus.

    Nystagums can also be caused by something as simple as a severe otitus media, or laybrinthitis.

    My son has ocular albinism with congenital nystagums. He has normally pigmented skin/hair/irises, but he is legally blind.

    Blessings


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