Paramedics Course – Assessing Pupils

Assessing Pupils

Micro-Lecture by the Australian Paramedical College

In today’s micro-lecture, Australian Paramedical College Hon. Snr. Lecturer Sam Willis talks about assessing the pupils which is one of the things you’ll routinely do as a Paramedic.

Assessing Pupils

In today’s micro lecture, we’re going to talk about assessing the pupils. Now, as a paramedic, one of the things that you will do routinely is to look into the patients eyes and look at what’s going on with their pupils. They can tell you a whole lot about how much oxygen the brain is receiving, as well as a range of different cardiovascular diseases that present in the eyes.

For the purposes of this lecture, we’re just going to look at the different pupil sizes and help you guys to see what is normal and abnormal.

First, let’s talk about when we would actually do this. So, you arrived on scene at the patients address, and you say, “Hello, ambulance.” And you greet them by shaking their hand, and they tell you their name. Straight away you can look into their eyes. Yes, we do danger, response, airway, breathing, circulation, but you can also look at their face, look at their size, look at their general appearance. Once of the things you can do in all of that, which is part of the patient assessment triangle that we’ve talked about previously, is to look at their overall appearance, and one of the things is to look into their eyes.

Pupils should be nice and round, and they should be dark black, and they should both react equally when you shine a light into them. Generally speaking, we do tend to use pen torches that are medical grade, and here’s a whole range, if you just Google “pen torches” as I’ve done up here, all these different torches come up. Some of them have these pupillary grades on the side, which will help you work out the number, which is fantastic. Try and avoid the LED ones that are going to cause your patient discomfort. Basically, just choose one of your very basic ones. It’s absolutely your choice, but for patient comfort, you’re trying not to blind them when you shine it in their eyes.

Now, on this pupillary scale, as you can see, it’s measured in millimetres, and it goes from one to eight, and I’m sure if does go to nine and ten, as well. As you can see here, two to six is considered normal. Just remember that when the patient is in a light room, then the pupils are going to be really small because the pupils don’t need to let in so much light, so they’re going to be pretty small, as opposed to a dark room, your pupils are going to be quite big.

There are some other things that can affect the pupillary response, and that includes excitatory drugs. When that happens, when you have excitatory drugs, the pupils tend to be bigger because your stimulating the sympathetic nervous system and it dilates the pupils to let light in, and as a consequence of stimulating the sympathetic nervous system, the pupils get bigger, as opposed to drugs that will make you … that will actually cause the absolute opposite of stimulation, therefore you will get an inhibition of the pupils and a constriction of the pupils, such as opioids.

When we use the term “pin point pupils” we’re generally talking number one. These patients need to really be given a drug called Miloxone or Narcan so that you can reverse that.

When you’re using a pen light to assess a patients eyes, make sure that the patient has acclimatised to the room that they’re in, get the pen torch and shine it into the eye like this, and out, and then likewise, in and out, and then shine it into the middle. In and out like this, you’re assessing one pupil. Again, assessing the pupil individually. Shining the torch into the middle, you’re assessing both of them at the same time.

Just remember, guys, that there are three nerves that control the eyes. One that controls the muscles in and out, and one that controls them up and down, left and right. Different muscles control different parts of the eyes.

That’s a whistle stop show of pupillary assessment.

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