When To Check PEARL

Veneficus said:
You would think nobody learned anything in ATLS class.

Sadly you are right, it is common. It is the exact reason EMS providers are told to take trauma patients to the trauma center, bypassing facilities if need be.

I worked for years in a major trauma center, it is also the focus of my career, in my opinion if you have a serious injury and you get taken to a community hospital, there are one of 2 outcomes. You will either be transferred right away, or you will lay there dying until you are beyond help by mortals.
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Isn't that protocol? (I've only been on two calls...but I thought that was protocol)
 
Calling Natasha Richardson

Pt fell, but what caused the fall? Did they experience a CVA leading to the fall (could be embolic or haemorrhagic) or did they trip on the dog and strike head (almost certainly haemorrhagic)? ETOH? Meds?Agreed, watch for horses not unicorns, and the data should rapidly point to the most likely dx.
 
mycrofft said:
Pt fell, but what caused the fall? Did they experience a CVA leading to the fall (could be embolic or haemorrhagic) or did they trip on the dog and strike head (almost certainly haemorrhagic)? ETOH? Meds?Agreed, watch for horses not unicorns, and the data should rapidly point to the most likely dx.
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^ this


I would also querry as to whether the patient would've had a positive outcome at all... pupils checked or not. Midline shift and herniation do not progress as rapidly as one would think, (barring pharmacological, pathological history) in healthy individuals, from a fall as described. If the patient was bleeding that badly, from the time EMS made first contact to the time she was in hospital (roughly an hour according to the timeline), it was a foregone conlusion.

Am I excusing or condoning the omission in assessment... no. But the argument in this case seems to be moot
 
A stands for "accomodation."
 
Answering the title (my mental passtime)

"Oh, Mondays between seven and twelve".

PERLA check is good, but serial checks are better. Timed and recorded serial checks are best. Change is not always good.
 
EMSLaw said:
You probably don't need a penlight to tell if the eyes aren't adjacent. ;)
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Yah. If someone's eyes weren't adjacent, then perhaps I'm really treating a chameleon... or someone whose head has been cleaved. I'd just have to call him "Cleaver"... or... ;)

Anyway, I used to check PERRLA whenever I did check the GCS, and of course, document the findings... That's two tasks that I can combine together and not have it take up too much extra time.
 
EMSLaw said:
You probably don't need a penlight to tell if the eyes aren't adjacent. ;)
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To be fair, you generally don't really need a pen light to check PEARL and definitely don't need one to check accomodation.
 
JPINFV said:
To be fair, you generally don't really need a pen light to check PEARL and definitely don't need one to check accomodation.
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Bingo!

If you are in a well light area, all you have to do is cast a shadow over their face to see the pupils react. Half the time I never have to use a flashlight to check pupils.;)
 
If you don't have a penlight... just use the 100,000 candlepower spotlight in the truck... :blink:
 
Three words:

Green laser pointer.

Fix those pesky retinal tears too.
 
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