A 40-year-old male motorcyclist is brought to the emergency department by paramedics after rear-ending a car at highway speeds. He was wearing a helmet but was thrown from his motorcycle. He was initially awake in the field but then quickly became unconscious. His airway is patent, and his respirations are shallow and irregular. His blood pressure is 190/90 mmHg, heart rate is 60/min, and respiratory rate is 20/min and irregular. In response to a sternal rub, the patient moans and withdraws his right upper and lower extremities, but he does not move the left upper or lower extremities, and he does not open his eyes. His Glasgow Coma Scale (GCS) is 7. His right pupil is 6 mm and nonreactive, while his left is 3 mm and reactive to light. There is no obvious head injury or laceration. There is no discharge from the nose or ears; however, there is a right hemotympanum. The oropharynx is clear. The remainder of the physical examination is normal.