Question about that (thanks for posting).
Yesterday I had a patient who complained of vision loss in her right eye in the lower right quadrant. She had ptosis of the left eye and the right eye was deviated to the right. None of the notes from the hospital noted either of these but family said that was how its been since it started. All neuro signs normal, it was a transfer for opthmology.
Page 7 addresses this, and says it could be 3rd nerve palsy. It sounds like it has to be the same eye deviating and with ptosis. Does anyone know? It'd be cool to maybe figure out that's what was wrong.
With all due respect, I don't care. sudden loss of vision in one eye should be treated as a stroke until proven otherwise. And by proven, I mean by an ER with a Neuro consult. Let them use all their tools and diagnostic devices to find out what was going on with the patient.
Would it be cool to find out? sure. Go ask the opthmology person what was going on with that person. Or have your supervisor/clinical coordinator request the information.
You can be a very smart and well educated EMT and Paramedic, but don't overthink things, and don't try to give the ER a specific diagnosis just because you have a little more information. If you don't have the tools to back it up (such as diagnosing AFib without a monitor, and yes, a former coworker did this), and you're wrong, you will be laughed at (either to your face or behind your back) by your coworker, no longer trusted by the ER staff, and while you might impress a lay person or newbie, no one with any education or experience will listen to anything you say in the future.
Pupils should be equal and reactive to light. if they are not reactive, it typically means there is some chemical in the body not allowing them to act normally (drugs, etc) but as long as they are in unision, at least whatever is happening is affecting both sides equally.
if they are acutely unequal, there is often a physcial reason why this is happening (head trauma, stroke, something putting physical presure on the brain to cause them to be unequal). These are bad, and are usually time sensative, and need a brain surgeon to go poke around and see what is going on and hopefully fix the problem.
Again, theses are typical presentations, and I'm sure someone will say that it isn't always the case
If the patient has a diagnosed condition resulting in abnormalities, her or she should be able to tell you. if the patient can't (for example he or she is unconc), then assume the worst and treat accordingly.
