–Polytrauma with traumatic brain injury due to road traffic accident involving multiple rib fracture, long bone fracture , pneumothorax, surgical emphysema and rupture of the left hemidiaphragm poses a serious initial pathophysiologic challenge in the form of onset of “ Lethal triad” i.e., metabolic acidosis, hypothermia & coagulopathy. Such patients need a proper triage, admission into a well equipped and committed trauma care centre with multispecialty departments, a well equipped ICU and round the clock interventional radiology, laboratory facility. Adoption of “Damage control surgery” can prevent “Second hit” injuries and improve survival.