A 26 year old male patient brought to SVIMS casualty with sustained stab injury below right collar bone. On examination patient was conscious, obeying commands. Pulse was feeble. Breath sounds were absent on right side. Under local anaesthesia intercostal drainage was placed on right side and 500ml fresh blood was drained. Pressure bandage was applied at wound site. Immediate blood sample for cross matching sent and blood was reserved. Later patient was haemodynamically unstable he was shifted to cardiothoracic operation theatre for emergency surgery.

Monitoring was connected to patient. Under strict aseptic precautions central venous catheter secured in right femoral vein and left radial artery cannulated for invasive blood pressure monitoring. Inotopes started. After induction with inj. Ketamine and injvecuronium patient was intubated with 8.0mm cuffed ET tube orally, air entry checked and connected to ventilator. Intraoperatively surgeons found laceration to right lung affecting pulmonary vein and artery at hilar region which was bleeding profusely. Patient systolic blood pressure dropped from 80 mmHg to 30 mmHg inspite of 4units of blood transfusion. Later surgeon decided to do pneumonectomy and asked for one lung ventilation. So patient reintubated with 35F left side double lumen ET tube and position was confirmed by auscultation and right lung was collapsed. Surgeon stapled right hilum and right pneumonectomy was done. Blood pressure gradually improved after transfusion of another 4units of blood and 4units of fresh frozen plasma. Cerebral protection was given. Surgery lasted for 4 hours. Patient shifted on ventilator to recovery room and gradually weaned. Patient was extubated after 12hours. Patient was discharged in haemodynamically stable condition after 10 days.