Severe trauma is an increasing global problem in people under 45 years of age, but a specialized trauma team for these patients may greatly reduce mortality. As in prehospital care, initial assessment in the Emergency Room is based on ABCDE, always remembering that trauma patients are dynamic.

Motor response, pupillary reflex, traumatic brain injury (TBI) characteristics, and age are the most reliable independent prognostic factors; moreover, specific to emergency room resuscitation management, the computed tomography (CT) scan will not only help to establish prognosis but also classify TBI severity and guide therapeutic decisions.

Specific treatment focuses on prevention and treatment of intracranial hypertension (ICH). This includes consideration of drugs for anesthetic induction and hemodynamic stability, as well as the choice of fluidotherapy, ventilation strategies, and specific intra-cranial pressure monitoring. Osmotherapy is only recommended when there are signs of transtentorial herniation. The role of tranexamic acid is still unclear, and corticosteroids should not be used routinely.

As for surgical treatment, this varies according to the type of hemorrhage found on the computed tomography scan and in cases of uncontrolled ICH, despite medical treatment, where procedures of choice are often cerebrospinal fluid drainage and decompressive craniectomy.