**4. Management**

Management of TBI with haemorrhagic shock remains a challenge [13] which is further compounded by the fact that there is wide variability in clinical practices. Various parameters must be kept in mind while managing this patient population, including intracranial pressure monitoring, a coagulation profile, an optimum blood pressure target, and the issue of performing combined surgical procedures for a combination of injuries [13]. In addition to the standard management protocol, the objective of management in these cases is "hemodynamic and haemostatic resuscitation" [13]. An optimal blood pressure management strategy will be necessary as there may be a combination of systemic hypotension and intracranial hypertension. It will be better to maintain the systemic blood pressure on the higher side [15]. The management strategy in these patients is debatable; however, the management should focus on the management of hypotension, cerebral oedema, coagulopathy (if present), judicious use of antiepileptics, and blood replacement [13]. As recommended, tranexamic acid can be given to reduce the mortality rate in these patients [16]. A few words of caution: aggressive fluid resuscitation in these patients must be avoided as it may have deleterious effects and increase short-term mortality [17]. Although head-end elevation is a standard practice in managing patients with TBI and raised intracranial pressure, its role in managing these patients is controversial [18]. Similarly, the role of the Trendelenburg position, which has been suggested to improve transient hypotension in haemorrhagic shock [19], is doubtful [20]. Maintain a neutral head and neck position to prevent jugular compression which would further impede venous return to the heart in the background of haemorrhagic shock.

*Introductory Chapter: Concomitant Traumatic Brain Injury and Haemorrhagic Shock DOI: http://dx.doi.org/10.5772/intechopen.108275*
