Re: [texasems- l] dimming lights before checking pupils

[Guest guest]

It would seem to make sense. Dim the lights to dilate the pupils then

apply the light. This provides a greater response and is a better

assessment of " Pupils equal and responsive to light " .

I'm not a " Physician Substitute " though..... HAHAHAHA.

Steve

From: texasems-l [mailto:texasems-l ] On

Behalf Of james davis

Sent: Sunday, July 03, 2011 5:57 AM

To: texasems-l

Subject: [texasems- l] dimming lights before checking

pupils

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)

[Guest guest]

Im not saying I have the correct answer, but I can give my opinion........to me,

it would seem quite appropriate to dim the lights if possible, as long as all

light sources are dimmed equally. My doctor AWAYS cut the lights completely out,

but he was also holding the light against the side of my nostril, which allows

you to see abnormal shadows through the skin. However, the dimming should be

equal. In a dimmed room, I once thought I had a pt with a blown pupil. Even the

doctor got nervous, till we realized, the lamp by the bed was causing it!

I'll keep my Guns, my Freedom and my MONEY,

You can keep the " CHANGE. "

Subject: [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)

[Guest guest]

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)

[Guest guest]

Oops. Typo. It should be, obviously, GAZE into the distance, not gave into the

distance.

GG

[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)

[Guest guest]

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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