You've been at work for 40, strenuous minutes. It's time to look after number one - feet up, cup of hospital coffee (contravenes the Trade Descriptions Act and outlawed in most civilised countries) and you're pretending to be engrossed in this month's 'Nature Neuroscience'. As usual the words dance around the page and all your higher brain functions slowly switch off.

Your 'calcium-channel signalling and cell apoptosis'-induced reverie is rudely interrupted by the trauma team activation call - which is lucky because you were just getting to total brainstem shutdown.

Your patient is a 19 year old male 'nocturnal vehicular test driver' who has lost control of the car and crashed it into a tree. On arrival he has stridorous respiration and a respiratory rate of 7. Glasgow coma score on scene was 6 and his pupils are equal and reacting to light.