The avoidance of thoracic surgical emergencies remains the goal of all thoracic surgery. Intraoperative prevention, prompt diagnosis and rapid correction are essential as thoracic emergencies can rapidly become fatal. The tension pneumothorax should be rapidly treated by chest drain insertion. Rigid bronchoscopy is recommended because of its greater suctioning ability and maintenance of airway patency. Echocardiography provides a rapid and effective means for diagnosing heart failure as well as several associated conditions, including pulmonary hypertension, valvular disease, adult congenital heart lesions, cardiomyopathies and pericardial disease. Mediastinoscopy remains a widely used procedure for the staging of lung carcinoma and obtaining a diagnosis for diseases in the mediastinum. As mediastinoscopy involves dissection and biopsy of tissue in the superior mediastinum around the great vessels, there is always a risk of hemorrhage. All patients having mediastinoscopy should have large bore peripheral venous access.