Pupils appear small but are reactive.
(d) Abnormal respiratory pattern noted (possibly Cheyne-Stokes).
(e) Initially, patient will try to remove painful stimuli. Later, the patient
withdraws from pain.
(f) As progression occurs, the pain will cause decorticate posturing
(flexion of the upper extremities with lower extremities becoming rigid and extended).
(g) Still reversible.
Progressive level two.
(a) Middle portion of the brain stem is involved.
(b) Blood pressure increases.
(d) Pupils become fixed at 3 to 5 mm and nonreactive or only
sluggishly reactive to light.
Abnormal respiratory pattern: fast, shallow panting (neurogenic
Progressive level three.
(a) Pupils become fixed and dilated.
(b) If only one "blown" pupil, it will be on the same side as the
hematoma or swelling. (Crossover of nerves occurs at about the lip level.)
Document which pupil dilates first.
(d) Respiratory ataxia (erratic, no rhythm) or absent.
(e) No response to painful stimuli.
Pulse is rapid and irregular.
(g) Decreased blood pressure.