Open Chest Wounds and Missed Injuries - A Really Opened Pandora's Box

The purpose of the study is to highlight the importance of systematic approach and investigation for identification of potential life threatening lesions to a serious injured patients with the presence of obvious other lesions. A clinical case patient, with penetrating transfixing chest trauma, severe shock and respiratory distress. HEMS emergency evacuation under aggressive resuscitation, to a regional trauma center. Further clinical examination, imagistic and complex biomarkers revealed cardiac, lung, spleen and spinal cord contusions. Emergency intervention practiced foreign body extraction, extensive exploration, regulate and surgical treatment of the wound trajectory. Two weeks later, the patient has been discharged from hospital without complications. 1. Patient with opened, penetrating chest trauma should be considered and managed as a life threatening situation but the assessment plan and the investigation strategy required should be extensive in order to identify all visceral both thoracic and abdominal tissues injuries, not only the life-threatening one, as cardiac contusion and spinal cord injuries. 2. Cardiac contusion is not a rare event, but a rare confirmed diagnosis, in association with other sources of shock or hypoxia, the result of traumatic complex of lesions, which include cardiac contusion, could thus impact on survival chances. 3. Air evacuation is, the first intention to assist such a patient in the trauma center.