![]() One dilated pupil suggests CN3 compression – e.g.fixed mid-sized pupils occur in midbrain lesions.pinpoint pupils occur in pontine lesions and certain overdoses (e.g.Different sized pupils correspond to different types of lesions.We need to assess the pupils for size, asymmetry and reactivity to light.Look for spontaneous breaths in the ventilated patient (may be suppressed if hyperventilated).Also look for deep rapid Kussmaul breathing, secondary to a metabolic acidosis, as in diabetes ketoacidosis.Central hyperventilation, or prolonged inspiratory pauses or irregular ataxic breathing indicates various brainstem lesions as does apnea.Cheyne-Stokes Respiration is not specific but is seen in lesions above the brainstem.Other scores such as the Richmond Agitation-Sedation Score (RASS) are used to titrate sedation (see Sedation in the ICU)īreathing pattern is often forgotten in intubated patients, but is important as the pattern of breathing correlates with the level of the lesion, and may suggest other causes. ![]()
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