Traumatic brain injury (TBI), also known as intracranial injury, occurs when an external force traumatically injures the brain. When multiple traumas complicate a head injury, there is no ideal crystalloid resuscitation fluid. A major concern during resuscitation is the development of cerebral oedema. Brain injury disrupts the blood brain barrier resulting in oedema formation, which is driven primarily by the capillary hydrostatic pressure. Recent studies show that a combination of crystalloids and colloids could be a more appropriate fluid regimen for resuscitation of traumatic brain injured (TBI) patients. Maintenance of haemodynamic stability is essential to the management of severe TBI as the injured brain may lose the capacity for vascular autoregulation, either globally or locally. The resuscitation of all head injured patients must be prompt and confirmed by serum lactate measurement. A fall in serum lactate to normal signifies adequate resuscitation. Substantial blood loss requires transfusion with cross matched or fresh whole blood. A minimum haematocrit between 30 to 33% is recommended to maximise oxygen transport. However, these recommendations should not be interpreted as indiscriminate volume replacement because, volume overload can have detrimental effects on the already traumatised brain.