Back ground: Chest injuries continue to be major healthy surgical problem. It is life threatening condition which can involve other anatomical area and worsen the general condition of patient. The common mechanism of injury being road traffic accidents, fire arms, falls, arrows, wild animal injuries, assaults etc. The injuries can involve thorax wall, lungs, mediastinum or diaphram. The common diagnosed conditions include frail chest, fractured ribs, contused lung, hemothorax, pnemothorax, oesophageal rapture, tracheabronchial tree injury, diaphragmatic injury, cardiac injury, tension pneumothorax, open pneumothorax etc. Treatment of severe thoracic trauma depends on effective prioritization of management based on the principals of ABC with a rapid identification of severe injuries and immediate surgical treatment of life threatening condition.

Case presentation: We report a case female patient 45yrs old, peasant with history of being hurt by an elephant trunk while working in the farm and sustained open left chest injury, none penetrating injury of right upper arm and severe loss of blood. She was examined and concluded to have open pneumothorax with exposed lungs, multiple rib fractures, and closed left humeral fracture. The patient was intervened by ATLS approach followed with successfully surgical treatment.

Conclusion: Severe traumatic chest injury sounds to have high mortality once management is delayed and improperly provided. It is possible to save these injured cases if protocol for the advanced trauma life support is properly followed and multidisplinary definitive surgical care, should be conducted when the patient is haemodynamicaly stable .

To be added..