It is 1000; Billy responds spontaneously with eyes open, is able to show you the thumbs up sign when asked, knows that he is at the clinic, that it is Tuesday, and that his name is Billy McGee. His temperature is 36.9°C; his pulse is 103 bpm, respirations 24/min, BP 100/70. Pupils measure 2 mm, are equal bilaterally, round, react briskly to light and accommodation. He has normal arm strength in both arms and legs. It is now 1100; Billy is drowsy but opens his eyes and responds when you call his name. He raises his hand when asked, but is confused about where he is, he just keeps asking for his mother and saying his head hurts. His temperature is 36.8°C; his pulse is 90 bpm, respirations are 22/min, BP 115/68. Pupils measure 2 mm, are equal bilaterally but his left pupil reacts sluggishly to light and accommodation, the right is still brisk. He is weaker in both arms and legs. It is now 1120; Billy does not respond to his name, his eyes remain closed, but he purposefully pulls his hand away with painful stimulus. He is making unintelligible sounds. His temperature is 36.6°C, his pulse is 80 bpm and bounding, respirations are 16/min, BP 130/55. The right pupil measures 2 mm, is round and briskly reactive to light and accommodation, left is 6 mm, fixed. He has severe weakness in all extremities.