Elevated intracranial pressure commonly is associated with severe head injury. Emergency airway management technique in the patient who has sustained severe head injury must optimize conditions for intubation, minimize the adverse effects of intubation, and permit rapid and effective management of the elevated intracranial pressure. Disturbances in autoregulation make the injured brain particularly susceptible to the adverse effects of alterations of systemic blood pressure. Airway manipulation without adequate pharmacologic support can cause precipitous changes in systemic hemodynamic parameters. This article reviews the physiologic and pathologic relationship among airway management, systemic hemodynamic parameters, and intracranial pressure. Specific recommendations for the use of neuromuscular blocking agents, anesthetic induction agents, and adjunctive medications are provided.