Remember that pupil response is just one, very small part, of the clinical picture. From a good history taking you should already have a pretty good idea what you're dealing with, physical findings, such as pupils will confirm that. Remember, 5-10% of the population have abnormal pupils whether from a congenital abnormality or a chronic disease process ... so without the context of a DLOC/Neuro complaint, abnormal pupil findings can get put into the "neato but not relevant" category. Its not quite so simple as, pupils = X, patient has y.
I can't remember where I read it, but there is an article that made a correlation between pupil reactivity in cardiac arrest pt's and their outcomes. Basically, the article stated that the chance of successfully resuscitating a pt with non-reactive pupils was pretty much nil. Anecdotally, the two cases in my short career thus far where I have had survival to hospital discharge, both had reactive pupils at the scene and all the pts that I've left on scene for the coroner didn't.
