Which of the following best describes the initial management priorities for a patient with severe TBI (GCS ≤8)?

• A. Secure airway only; imaging later.
• B. Start rehabilitation immediately.
• C. GCS ≤8: secure airway, rapid assessment, CT scan, consider ICP monitoring, and neurosurgical consult.
• D. Proceed to MRI first before any intervention.

Answer: (C)

In severe traumatic brain injury, the priorities are to stabilize the patient first and then rapidly identify and address life-threatening brain injuries. The airway is the top concern when the GCS is 8 or lower because these patients are at high risk of airway compromise, hypoxia, and aspiration. Securing the airway—usually with endotracheal intubation—and protecting the spine sets the stage for giving the brain and body the oxygen they need.

Once the airway is secure, the focus shifts to quick, comprehensive assessment and imaging. A rapid neurological exam is performed and a head CT is obtained emergently because CT is the fastest, most sensitive way to detect bleeding, mass effect, skull fracture, and other acute injuries that require urgent decisions. The goal is to identify conditions like epidural or subdural hematomas, contusions, or signs of rising intracranial pressure that demand prompt action.

Consideration of intracranial pressure monitoring and a neurosurgical consultation follows, because many patients with severe TBI will benefit from continuous ICP monitoring to guide therapies that protect brain perfusion, such as hyperosmolar therapy, controlled ventilation, and, when needed, surgical intervention. MRI is not used first in the acute setting due to longer scan times and the need for rapid information to guide urgent management.

So, the best approach captures airway stabilization, rapid assessment, CT imaging, consideration of ICP monitoring, and early neurosurgical input—together forming the sequence that aligns with how severe TBI is managed in the emergency and trauma context.