The chest is frequently injured by both penetrating and blunt trauma. The vast majority of thoracic trauma patients do not require thoracotomy and are successfully managed by tube thoracostomy and supportive measures. A critical diagnostic challenge in patients with thoracic trauma is the possibility of a life-threatening injury. Specific life-threatening thoracic injuries should be suspected, diagnosed, and treated during the initial primary survey. These are airway obstruction, tension pneumothorax, cardiac tamponade, massive hemothorax, open pneumothorax, and frail chest.