Thoracic trauma accounts for 25% of all trauma related deaths. The majority of thoracic trauma patients can be managed conservatively by simple chest tube drainage, respiratory support and pain management. The mechanism of injury after thoracic trauma can be classified as blunt or penetrating trauma. The anesthetist plays an important role in the management of severe thoracic trauma from an initial stage of primary survey right through to management in the intensive care unit. In the emergency department, decisions and actions have to be taken without delay. In a trauma situation, there is little opportunity to obtain standard anesthetic pre-operative assessment. Video-assisted thoracic surgery is an important and extensively used diagnostic tool for suspected traumatic intrathoracic lesions, including stab wounds, in hemodynamically stable patients. Urgent thoracotomy is indicated in the presence of severe hemorrhage. A quick standard anesthetic assessment should be performed on all trauma patients.