Re: Recommended light for checking pupils?

[Guest guest]

thanks for all the replies. i appreciate it.

________________________________

To: texasems-l

Sent: Tuesday, July 5, 2011 3:01 PM

Subject: Recommended light for checking pupils?

 

I've been using either gimme lights from vendors, or cheapo lights from

Walmart, for pupils, and general field exams. Does anyone have a light

that they recommend (one that's portable enough to carry in a pocket, or

belt, or in jump kit).

Steve

> Agree with the need for a darkened room- I don't have my copy of Degowan

> and Degowan's Physical Exam handy, but if you think about it, if there is

> much light in the room, watching for pupillary constriction is much tougher

if

> the pupils are already constricted from ambient light.

>

> there are other tests that you need to know about.

>

> In addition to the traditional 'approach from the side' constriction test,

> you also want to do the 'swinging lamp test'....where the light is passed

> from side to side from the front of the eyes.

>

> a positive test is where the pupil constricts from indirect stimulation

> (light in the opposite eye) but not from direct stimulation- indicating

> problems in the retina, optic nerve or brain stem. See Marcus Gunn pupil.

>

> the third test of pupillary activity is to watch for constriction as the

> patient is asked to follow a moving finger. Both pupils should constrict as

> the finger moves closer to the nose (accommodation).

>

> If the pupils constrict to accommodation, but one or both do not react to

> light, then tertiary syphilis should be suspected (see Argyll on

> pupil).

>

> ck

>

>

> In a message dated 07/04/11 23:16:18 Central Daylight Time, wegandy@...

> writes:

>

> > From Jarvis, Physical Examination and Health Assessment, 3rd edition,

> Saunders, 2000, Ch. 12, p. 315:

>

>

> " To test the pupillary light reflex, darken the room and ask the person to

> gave into the distance. (This dilates the pupils.) Advance a light in

> from the side and note the response. Normally you will see (1) constriction

> of the same sided pupil (a direct light reflex) and (2) simultaneous

> constriction of the other pupi (a consensual light reflex.). "

>

>

> > From Tintinalli, Tintinalli's Emergency Medicine, 7th ed., American

> College of Emergency Physicians, 2011, Ch. 236, p. 1522:

>

>

> " Assess pupils under slightly dim light to test for an afferent pupillary

> defect. "

>

>

> Gene Gandy

>

>

>

>

>

> [texasems- l] dimming lights before checking pupils

> To: texasems-l

> Date: Sunday, July 3, 2011, 5:57 AM

>

>

>

> I have a job basically doing physical exam

>

> On people all day , every day. I, out of habit, and because I can, dim the

> lights before checking their pupils . I was told by our physician that "

> it's not clinically appropriate to dim the lights before checking

> pupils " no further explanation. No specific reason given. (even after asking

for

> the rationale) Just that isolated statement.

>

> Anyone else here thing that is strange or bizarre or weird or is it just

> me???

>

> Jim

>

> Physician Substitute ( just a fancy title- I'm a medic)

>

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