Decision-making is a complex issue especially in severe multi-pathological patients, whose processes interact with each other and with other treatments, making it impossible to follow regular protocols. In this case, the patient suffered from a cranioencephalic traumatism and a pulmonary thromboembolism. In the case of pulmonary thromboembolism, an anticoagulation prophylaxis is recommended while in the former it is contraindicated. Moreover, complications may appear, apparently related or not to main diseases. In these situations, it is essential to establish priorities and have a vast knowledge of patients' pathologies and the possible complications that may emerge. Firstly, our aim was the resolution of the brain trauma due to the mortal risk of brain herniation. Straightaway we relieved the severe subsequent complications of the main processes, namely, refractory intracranial hypertension, acute respiratory failure and thrombocytopenia. Once the patient was stable, pulmonary thromboembolism treatment could be set and followed after clinical improvement and discharge.