First, the scene of first aid measures 1, prevention of asphyxiation as soon as possible to pull out the blood clots and vomit in the mouth and throat, place the patient in a lateral position, head back to hold up the jaw; with the tongue back fall, place the oropharyngeal ventilation tube; if necessary, tracheotomy. 2, proper wound management Scalp laceration and avulsion injury, immediately pressure bandage to stop bleeding; open cranial injury, placed around the exposed brain tissue gauze roll, and then covered with dry gauze appropriate bandage; follow medical advice as soon as possible to use antibiotics and TAT to prevent infection. 3, anti-shock General closed craniocerebral injury (except for pediatric) does not cause serious shock. Once the signs of shock, should consider the combination of other parts of the injury, such as multiple fractures, rupture of internal organs. Immediately place the patient in a flat position, keep warm, replenish blood volume, and help find the cause. Record the injury, examination, first aid treatment and the evolution of the patient’s consciousness, pupils, vital signs and limb movement for reference in further treatment. The state of consciousness is the most important condition observation index, which can be judged by the reaction to speech stimulation, reaction to pain stimulation, physiological reflexes, control of urination and defecation, and the process of the five aspects of the examination, or by the reaction to eye opening, speech and movement. The degree of impaired consciousness can be considered as the severity of brain injury; the early and late appearance of impaired consciousness and the presence of continued aggravation can be used as an important basis for distinguishing primary and secondary brain injury. 2, vital signs After the injury can appear continuous disorders of vital signs. (1) temperature: there can be moderate fever at the early stage after injury, for absorption fever, hypothermia or central hyperthermia for mesencephalic or brainstem injury. (2) respiration: pay attention to the respiratory rhythm, depth, the presence of slow breathing, sigh-like breathing, respiratory distress or respiratory arrest. (3) Pulse: pay attention to the rate and rhythm, whether it is slow, large and strong or fast, weak and uneven. (4) Blood pressure: pay attention to fluctuations in blood pressure and changes in pulse pressure. Changes in single indicators should be looked for causes, and simultaneous changes in several indicators should alert to increased intracranial pressure due to secondary hematoma. 3. Neurological signs have localization significance. Secondary intracranial hematoma should be suspected if one of the following conditions is present (1) The neurological signs appear only some time after the injury. (2) The appearance of new signs in addition to the original signs. (3) Progressive aggravation of the original signs. The neurological signs are diverse, and the observation of pupil and pyramidal fasciculus signs should be focused. (1) Pupillary changes: have important clinical significance. The following changes are common: Ⅰ: bilateral pupil narrowing and blunted light reflex, accompanied by central hyperthermia and deep coma, as a manifestation of cerebral bridge injury. Ⅱ: bilateral pupil dilatation, loss of light reflex, eye fixation, accompanied by deep coma or decerebrate tonicity, mostly primary brainstem injury or pre-terminal signs. Ⅲ: bilateral pupil size variable, disappearance of light reflex, with eye separation or ectopic, mostly for the manifestation of midbrain injury. Ⅳ: Dilated pupil on one side immediately after injury, seen in optic nerve, iris and articulating nerve injury. V: one side of the pupil is first narrowed after injury, followed by dilatation, with increased impairment of consciousness, and is located in the cerebellar curtain incision herniation signs. ② cone bundle signs: compare the muscle strength, muscle tone, sensation and pathological reflexes of both sides, the following cases are common: I: unilateral paralysis, after excluding fracture, dislocation and soft tissue injury, injury to the motor area of the contralateral cerebral cortex should be considered. Ⅱ: paralysis of the upper and lower extremities on one side immediately after injury, and relatively stable, mostly with extensive damage to the motor area of the contralateral cerebral cortex. Ⅲ: crossed paralysis, i.e. peripheral cerebral nerve paralysis on one side and central paralysis of the contralateral limb, as a manifestation of brainstem injury. Ⅳ: paralysis of one limb appears some time after the injury and is progressively aggravated, supratentorial hematoma causing cerebellar curtain incision herniation should be considered.