"The patient is a thirty-four-year-old Caucasian female, admitted at one this morning via the trauma service after a high-speed head-on collision on Route 90. She was intubated and stabilized in the field, then airlifted here. On arrival to the ER, she had evidence of multiple trauma. There were compound and depressed skull fractures, fractures of the left clavicle and humerus, and severe facial lacerations. On my initial exam, I found her to be a well nourished white female, medium build. She was unresponsive to all stimuli with the exception of some questionable extensor posturing-'

"Questionable?" asked Dr. Wetfig. "What does that mean? Did she or did she not have extensor posturing?"

Abby felt her heart hammering. Shit, he was already on her case. She swallowed and explained, "Sometimes the patient's limbs would extend on painful stimuli. Sometimes they wouldn't."

"How do you interpret that? Using the Glasgow Coma Scale for motor response?"

"Well. Since a nil response is rated a one, and extensor posturing is a two, I suppose the patient could be considered a… one and a half."

There was a ripple of uneasy laughter among the circle of residents.

"There is no such score as a one and a half," said Dr. Wettig.

"I'm aware of that," said Abby. "But this patient doesn't fit neatly into-'

"Just continue with your exam," he cut in.

Abby paused and glanced around at the circle of faces. Had she screwed up already? She couldn't be sure. She took a breath and continued. "Vital signs were blood pressure of ninety over sixty and pulse of a hundred. She was already intubated. She had no spontaneous respirations. Her rate was fully supported by mechanical ventilation at twenty-five breaths per minute."

"Why was a rate of twenty-five selected?"

"To keep her hyperventilated."

"Why?"

"To lower her blood carbon dioxide. That would minimize brain edema."