Shock or acute respiratory failure developing soon after chest trauma are associated with extremely high mortality and morbidity rates. In a study of 1,136 patients with chest trauma admitted to Detroit General Hospital during a 2-year period (1974-1975), it was found that 218 (19%) had shock or acute respiratory failure when first seen in the Emergency Department. Of these patients, 36% (78/218) died and the survivors had a complication rate of 63% (88/140). Shock was associated with a mortality rate of 7.3% (7/96) but the combination of shock and respiratory failure was particularly lethal, with a mortality rate of 73.1% (57/78)overall. No patient over 45 years of age survived this combination. Efforts to improve results following chest trauma must be directed toward earlier and more aggressive management of both these problems