New traumatic brain contusions may rapidly result in increased intracranial pressure (ICP). This chapter discusses how to recognize early increased intracranial pressure. The first line of ICP control is provided in this chapter. Placement of an ICP monitor, maintaining safe levels of ICP and cerebral perfusion pressure, and use of hypertonic saline are discussed, as is the importance of treating infections without delay. The effects and side effects of different osmotic diuretics are also discussed. Last-resort measures for refractory ICP are induced hypothermia or decompressive craniectomy. The chapter summarizes the major priorities of care in the first hours after traumatic brain injury.