Global mortality of mediastinal penetrating traversing wound is 20%. And it arises to 40% in hemodinamically instable patients. Incision chosen is one of the hallmarked of injury chest, due that there is no incision that allows exploration of all chest structures and wrong incision may compromise treatment of several important injuries and may deteriorate the patient. Which incision do you choose in an unstable patient? To answer this questions three cases are present. Bilateral thoracotomy was done. Case 1 - Emergency room bilateral thoracotomy was done and revealed Innominate vein injury and it was treated with suture. Case 2 - A lung injury was detected, the bullet near pulmonary artery was taken out and right mammary artery injury was treated. Case 3 - Superior right lung lobe injury was detect with pulmonary air leak and active bleeding. Sudden patient presents a cardiac arrest. Pericardium was opened and internal cardiac massage was performed. To avoid bleeding and air embolism right pulmonary hylium was crossclamp.