Acute subdural hematoma (ASDH) is a serious and potentially life-threatening condition that requires prompt and effective management in the emergency department (ED). This review article aims to provide an overview of the current evidence-based management strategies for ASDH in the ED setting. The article begins by discussing the pathophysiology of ASDH, emphasizing the rapid accumulation of blood between the dura mater and the arachnoid membrane following a traumatic brain injury. This can lead to increased intracranial pressure and potentially fatal brain herniation if not promptly addressed. The review then outlines the initial assessment and resuscitation of patients with suspected ASDH in the ED. The article then delves into the specific management strategies for ASDH in the ED, including the role of neurosurgical consultation, and the potential need for emergent surgical intervention to evacuate the hematoma and relieve pressure on the brain. In conclusion, this review article provides a comprehensive overview of the current evidence-based management of ASDH in the ED, emphasizing the importance of prompt recognition, accurate diagnosis, and timely intervention to optimize patient outcomes.