A Level I trauma alert gunshot wound to the head is paged out by EMS and they are at the back door of the ambulance bay with a 32-year-old man. Per EMS report, the man was shot in a drive-by shooting. The patient is being ventilated by bag-valve mask. He has a Glasgow Coma Scale score of 7. He has an obvious gunshot wound to his left temple and the crown of his head, with brain matter exposed. Upon your assessment you also notice some stippling. He is tachycardic and hypertensive, with bilateral breath sounds and good distal pulses. What is meant by stippling?