NREMT Paramedic Practice

What is an indicator that a patient may not be survivable if they exhibit increased ICP with labile pulse and QRS changes?

1. Stable blood pressure

2. Unilateral pupil dilation

3. Hyperthermia

4. Resting bradycardia

The correct answer is: Unilateral pupil dilation

Increased intracranial pressure (ICP) is a critical condition that can lead to severe consequences and indicates potential brain injury or dysfunction. When assessing a patient with increased ICP, certain indicators can suggest a poor prognosis or non-survivability. One such indicator is unilateral pupil dilation. This condition occurs when the pressure within the skull affects the cranial nerves responsible for pupil size regulation. Specifically, anisocoria (unequal pupil sizes) can indicate that one side of the brain is being compressed, often due to a herniation process. When the brain tissue is displaced, it can lead to significant neurological compromise and suggests that the brain is under severe stress. Therefore, unilateral pupil dilation becomes a critical sign that the patient's neurological status is deteriorating, aligning with a potentially poor outcome. In contrast, stable blood pressure may indicate that the patient still has adequate cardiovascular status, and hyperthermia could be due to other factors such as infection or environmental influences, not directly tied to the survival prognosis in this context. Resting bradycardia can indicate increased ICP and a possible Cushing's reflex, but it may also be a compensatory mechanism rather than a definitive sign of non-survivability. Thus, unilateral pupil dilation is a key