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Okay, so now what part of the assessment, part of the triage, if a patient has a head injury or a patient has any neurological deficit anywhere, it may be due to a problem in the brain. And what can happen is that the brain swells and just applies pressure on the optic nerve. So how we can see if that is happening is with a pen light. This is cleaned before use and the clip here, you just press the clip and it turns the light on and off.

So we shine the light into both eyes and we are looking for the pupils retracting, getting smaller when one eye is exposed to light. They should both retract together when one eye is exposed to light. And then you check the other eye to see that they are exposed to... That they retract when they are exposed to light as well. So if you bring the light in from the side of the patient here, sometimes you have to shade the eyes to get the pupils to dilate a little bit, so long as when you are measuring this eye right here, your left eye, the light is not shining through onto your right eye here, so we are getting a false reading.

So I always shade the eyes a little bit, bring the torch light in from the side of your head and just round a little bit to get that reflex, that pupillary reflex. And so we have seen there that your left eye, when exposed to light, is contracting and then when I take the light away, it is dilating. And we do that one more time, but instead of watching the right eye, we look at the left eye and just make sure that the left eye is also retracting. And then when the light is moved away, it is dilating as well. And we use the same procedure for your left eye twice, once looking at the eye that you are shining the light in, and once looking at the eye that is not being exposed to light. And they should retract and dilate simultaneously, so those pupils would be equal and reflexive to light.

On pen torches there is a sliding scale here, the difference of the pupil size and they are all numbered, so when you record on the system, you can record the pupil size as 1, 2, 3, up to 9, and these are in millimetres, so if you have got a patient who has their optic nerve compressed on one side only, it will be making the pupil dilate artificially, so if the pupils are unequal, that is a sign of a neurological deficit and the patient needs to go straight to A&E.