Severe traumatic brain injury is a life-threatening damage to the brain structure and function. It encompasses a variety of lesions, whose common characteristics include loss of consciousness and coma. It is usually classified using the GCS, in which a total score of 8 or less corresponds to severe brain injury. The diagnosis is based on clinical presentation and is confirmed by a medical imaging technique. Airway management, protecting the cervical spine with immobilization, ventilation, oxygenation, ensuring optimal systolic blood pressure, and early detection of signs of intracranial hypertension are critical strategies in the prehospital setting to maximize good outcomes. Even brief periods of hypoxia and hypotension are associated with worse outcomes. Neurologic status should be monitored and reassessed using pupil examination and GCS. A CT scan should be performed as quickly as possible in the hospital setting, as it can identify potential hemorrhages, contusions or fractures. Some cases demand surgical procedures, such as placement of intracranial pressure monitoring device, decompressive craniectomy or hematoma evacuation. Intensive care treatment efforts are aimed at ICP management and maintenance of cerebral perfusion, as well as optimizing oxygenation and blood pressure, managing temperature, glucose, seizures, and thromboprophylaxis. ICP can be managed by means of head elevation, brief hyperventilation, sedatives and osmotic agents, or neurosurgical intervention. In the post-acute phase patients receive multiple types of interventions to assist them in recovering from the physical, cognitive, emotional, and behavioral consequences of their injuries.