We all know that the dreaded bilateral fixed and dilated pupils is a sign of something bad after a traumatic event. But how bad is it? When you see this sign, what do you tell the family? Will their son, daughter, husband, wife, father, mother, ever be the same? Well doctor, how bad is it?
One study suggests that if a trauma patient who has bilateral fixed and dilated pupils on scene with a true GCS3, they have no real appreciable chance of survival. It would be wise to discuss comfort care measures at this point. Only 6 in this study survived and all of them had a GCS higher than 3 at some point in their care.