A 17 year-old male arrived at the ER with multiple gun shot wounds to the anterior and posterior thorax, conscious but with respiratory distress. His vital signs were: BP: 90/60 mmHg, RR: 150/min, RR: 40/min. The E-FAST was positive for fluid in his abdomen and doubtful in his pericardial window with bilateral hemo-neumothorax, He had no abdominal pain and he couldn´t mobilize his legs. The injuries were in the posterior midline (T10), in the mid scapular left line (T12) and in the right anterior axillary line in 7th intercostal space. Massive transfusion protocol was activated and in the OR a REBOA was inserted in the right common femoral artery and the ballon inflated in zone I. The we inserted bilateral thoracostomies, with drainage of 1000ml of blood from the left side and air from the right.In the median laparotomy, a grade III hepatic injury in segments VII and VI was found which was packed; a transdiaphragmatic pericardial window was positive and the cardiac tamponade of 200 ml was released. REBOA was deflated after 7 minutes due to a possible cardiac injury. A median sternotomy was performed with the Gigli saw; and a 3cm grade III cardiac injury was identified wich we repaird with U Stitches, at the apex of the right ventricle on its posterior-lower side. In the abdomen, the hepatic packing was removed and the injuries were sutured. The patient was hospitalized for 11 days without postoperative complications. He presented paraplegia due to the spine injury.