 4. Signed informed consent from the patient or obtained via their legally authorized representative if the patient is not able to sign the informed consent themselves. The patients decisional capacity to either provide or refuse consent will be determined using the Glasgow Coma Scale GCS, which is being assessed at baseline and at 24 hours -6hrs after enrollment. A potential study participant with a GCS 14 will be asked to provide their own initial study consent. A GCS 14 would indicate the need to pursue consent via legally authorized representative. 