Secondary brain injury is associated with a reduction in cerebral blood flow, oxygenation and perfusion related to hypotension, hypoxemia and raised intracranial pressure. This has been confirmed on autopsy and is associated with a higher mortality rate, as supported by many studies 1-11. The primary goal of nursing management in severe head trauma is to maintain adequate cerebral perfusion and improve cerebral blood flow in order to prevent cerebral ischaemia and secondary injury to the brain. This literature review included a Medline and CINAHL search for published and unpublished research, a manual search of recent literature, a citation review of relevant primary and review articles, contact with primary investigators and clinical observation of case studies using the latest cerebral perfusion research technology. Expert critical care nurses were observed and their practice noted as they cared for severely head-injured patients. The majority of the evidence was derived from class II and class III classifications, which provide guidelines and options for practice. Nursing and medical management were found to overlap, with the focus for the nurse being an integrated balance of scientific, technical and humanistic management. The nurse's role is extremely important because the expert nurse cognitively manipulates many variables over a continuum of care and, if such tasks are skillfully and successfully performed, the incidence of secondary brain injury is reduced.