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There is always a considerable amount of debate generated when it comes to issues of managing raised intracranial pressure secondary to post-traumatic head injury (based on clinical and radiological signs) in the ED.

When the case is clearly one for neurosurgical intervention (like clearing a large extradural or subdural bleed), then there is hardly any problem. However, in some cases of DAI (diffuse axonal injury) where there is loss of grey and white matter differentiation with other evidences of raised ICP there is usually differing opinions on the best way to manage.

Do any of the readers have any strategy, thoughts or experience in dealing with this group of patients. Does your department have any guidelines on emergent management of raised ICP where surgical intervention may not be indicated (barring insertion of ICP bolt)!