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Mortality after severe craniocerebral trauma still ranges between 18 and 50 percent. The author describes the hypertensive and hypotensive syndromes occurring directly after severe brain injury. The task of emergency medical care is to prevent secondary hypoxic damage to the brain that significantly aggravates the damage caused by the injury. The basic measures include: assessment of the state of consciousness according to the Glasgow Coma Scale, elevation of the head and chest by 30 to 40 dgrs. and fixation of the head in the mid-position with a collar, control and support of ventilation (intubation and oxygenation) and control of circulation. Drug treatment of raised intracranial pressure and basic monitoring directly after brain injury are described.