To present an evidence-based approach reviewing the acute management of concussive brain injury in sport. All published articles on the acute management of sport-related brain injury were extracted using searches of computerised databases (Medline, Embase, Sport Discus) as well as detailed literature reviews based upon the published bibliographies in this area. The review details the aspects where prospective scientific data is available upon which to base clinical management strategies. The first few minutes after an athlete receives a concussive injury provides a window of opportunity during which time the initial medical management forms a crucial and potentially lifesaving treatment. All clinicians involved in care of the concussed athlete need to have an understanding of the early management of the concussed athlete and a strategy by which they may manage such problems. An efficient and appropriate response to the immediate concussion management will help minimise the potential sequelae which may impact upon the athletes ability to return to sport.