Venous injuries have the added risk of air embolism.
Serious vascular injuries may be masked by the severe shock state in the patient with multiple injuries. These may become apparent only after resuscitation has begun. Suspicion of vascular injury requires early exploration. Anterior thoracotomy in the third interspace on the involved side permits immediate intrathoracic access to the great vessels. Bleeding sites can be controlled with direct pressure and packs while developing definitive exposure.