Emergency Medical Minute

Episode 980: Brain Injury Guidelines (BIG)

Published: October 27, 2025

Duration: 3:17

Contributor: Aaron Lessen, MD

Educational Pearls:

Traumatic Brain Injuries are a frequent complaint in the Emergency Department and have increased in recent years. The American Association for Surgery of Trauma (AAST) has created Brain Injury Guidelines (BIG), in an attempt to categorize brain injuries and the level of treatment they require. They are…

BIG 1

Normal neuro exam Not intoxicated Not on anticoagulation or antiplatelet medications Minimal findings on head CT No fracture 8 mm bleed (subdural, epidural, intraparenchymal (or more than 2 locations)) "Scattered" subarachnoid hemorrhage Intraventricular hemorrhage     Full treatment, admission to trauma center, neur...