Blunt chest injuries are common encounters in the emergency department. Instead of a comprehensive review of the management of all chest injuries, this review focuses on injuries that can be difficult to diagnose and manage, including blunt aortic injury, cardiac contusion, and blunt diaphragmatic injury. This review also discusses some recent controversies in the literature regarding the use of prophylactic antibiotics for tube thoracostomy and the optimal management of occult pneumothorax. The article concludes with a discussion of the management of rib fractures in the elderly.