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학습 자료 둘러보기 →In severe traumatic brain injury, bilaterally fixed and dilated pupils are the most critical finding, indicating uncal herniation with compression of the oculomotor nerve (CN III) and brainstem. This signals imminent, irreversible brainstem failure and requires an immediate, emergent response to lower intracranial pressure (ICP).
Prioritize interventions by recognizing the progression of deterioration. A drop in Glasgow Coma Scale (GCS) is an early warning, and an ICP reading above 20 mmHg is a treatable threshold. The presence of Cushing's triad (hypertension, bradycardia, irregular respirations) is a late sign, but bilateral fixed pupils represent the most advanced and immediately life-threatening stage.
Do not confuse a unilateral fixed pupil with the bilateral presentation. A unilateral fixed pupil is a critical early herniation sign requiring urgent action, but bilateral involvement confirms a catastrophic, often irreversible, brainstem injury demanding the highest priority.
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