Emergent thoracotomy is indicated here in the hypotensive patient who has not responded to an initial fluid challenge. This patient had a through and through wound of the left and right ventricle which was controlled in the emergency room.

Isolated fluid resuscitation is of no benefit to the penetrating trauma victim and may be harmful by delaying surgery and increasing blood loss from the site of injury. Operative intervention is the imperative and fluid resuscitation should occur simultaneously with this.

If this patient had been haemodynamically normal, arch angiography would be an appropriate investigation. However the degree of shock exhibited by this patient would have almost certainly have resulted in death had he been transferred to the angiography suite rather than undergoing immediate surgery.