A 40-year-old man was transferred to our trauma center by helicopter after being injured in an explosion in a factory. He presented with unstable vital signs and a Glasgow Coma Scale of 11. His left arm was nearly amputated, and his left lung was visible because of a crush injury to his chest wall. After intubation and blood transfusion, a log rolling maneuver was performed for inspection of his back. Bowel evisceration was noted at the posterolateral area of the thoracic cavity, and diaphragmatic rupture was suspected. After wrapping the wound, the patient was moved to the operating room without undergoing any imaging study.