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Secondary brain injury is a pathogenic process of brain beyond the primary brain injury. Which is caused by intracranial brain injury and extracranial brain injury, leading to impaired cerebral blood flow regulation, reduced cerebral perfusion and cerebral ischemia. The primary goal of nursing management in traumatic brain injured patient is prevention and risk reduction of secondary brain injury, to lower mortality and morbidity by avoiding hypoxia as well as maintain oxygenation. The goal should be euvolemia and avoidance hypotension. Elevated intracranial pressure can be treated through positioning, hypothermia, decreasing oxygen consumption and brain metabolism, close monitoring of neurological sign and vital sign, avoiding any interventions that hinder the balance, and maintain adequate cerebral perfusion and improve cerebral blood flow in-order-to prevent cerebral ischemia and secondary brain injury.