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So think of the skull as a closed box. It does not stretch. When the brain bleeds or swells inside it, something has to give, and that something is pressure.
That's intracranial pressure — the pressure inside the skull, pushing against the brain. As it climbs, it's going to squeeze the brain toward the only opening the skull has, the hole at the base where the spinal cord exits. That's herniation, and it's what kills a head-injured patient.
You cannot fix a bleeding brain in the field. But you can keep from making it worse. Your whole job on this call is oxygen in, blood pressure up, and get the patient to a trauma center before that pressure wins.
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