PERRLA in the ICU

[lilacskies13]

Hi all. I am a new nurse in a large hospital's ICU. Many of my patients are sedated, on ventilators, and even some pharmacologically paralyzed. I want to make sure I am performing PERRLA correctly as our assessments are very important in guiding patient care. Is it possible for sedated patients to have accommodation? My judgement and experience leads me to think its not possible, but I want to be sure. A lot of nurses chart PERRLA which confuses me when the patient doesn't follow commands and/or is unconscious.

[TheSameVein, BSN, RN]

I asked this same question on orientation when I first started and came to the conclusion that it's fine to write PERRL (pupils equal, round, reactive to light) in my notes and just leave off the "A". I think people just write PERRLA out of habit.

[KeepinitrealCCRN]

So a few things to note here prop/fent for vent purposes should not affect a patients pupils. Unless there is a neuro aspect or some kind of anatomy/defect all pupils will be reactive. The most important thing though is you should be pausing all sedation (unless contraindicated) and do a thorough neuro exam at the beginning of your shift to get a true assessment. A lot of pts wake up easily and follow commands even without pausing their sedation.