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Background: The 25% of traumatic deaths are due to chest trauma with a mortality of 28%, and closed trauma is the most common mechanism of injury. The use of firearms increases the relative risk of death. The five more frequent specific chest injuries are lung contusion (31.8%), hemothorax/ pneumothorax (19.4%), rib fractures (13.2%), and diaphragmatic injury (7.5%). Clinical case: Patient of 25 years with a single firearm projectile wound in the chest who assisted to the emergency room (ER) with significant respiratory distress and meriting surgical emergency airway, documenting double pneumothorax, aortic laceration and rupture of the trachea, which required management in the ER with bilateral chest tube placement and subsequent surgical repair. Conclusion: Anatomical and pathophysiological knowledge and the standardized management of the international guidelines are the key to keep a high level of suspect with a patient with chest penetrating trauma. Besides they improve the possibility of diagnosis and timely treatment. [ABSTRACT FROM AUTHOR]