Cardiothoracic Surgery

Lesson Objectives

By the end of this topic, learners should be able to:

1. Identify common cardiothoracic surgical conditions and procedures.

2. Understand the pathophysiology and indications for surgery.

3. Recognize post-operative complications and monitoring requirements.

4. Apply nursing and medical care principles in perioperative and post-operative settings.

 Key Glossary Terms

1. Thoracotomy

• Definition: Surgical incision into the chest wall to access the thoracic organs.

• Indications: Lung resection, esophageal surgery, trauma repair, mediastinal tumors.

• Approaches: Posterolateral, anterolateral, median sternotomy (for cardiac surgery).

2. Lung Resection

• Types:

  • Lobectomy: Removal of a lung lobe

  • Pneumonectomy: Removal of entire lung

  • Segmentectomy/Wedge Resection: Limited removal of lung tissue

• Indications: Lung cancer, bronchiectasis, trauma, infection

3. Esophageal Surgery

• Procedures:

  • Esophagectomy (removal of esophagus)

  • Fundoplication (anti-reflux surgery)

• Indications: Cancer, severe gastroesophageal reflux disease (GERD), achalasia

4. Chest Trauma

• Blunt Trauma: Rib fractures, pulmonary contusion, hemothorax, pneumothorax

• Penetrating Trauma: Stab or gunshot wounds

• Management Principles:

  • Airway stabilization

  • Chest tube insertion for pneumothorax/hemothorax

  • Surgical repair for major vessel or lung injury

5. Chest Drain (Thoracostomy Tube)

• Definition: Tube inserted into pleural space to evacuate air, blood, or fluid.

• Nursing Care:

  • Monitor drainage volume and color

  • Ensure tube patency and secure connection

  • Maintain suction as prescribed

  • Observe for subcutaneous emphysema or infection

6. Cardiothoracic Post-Operative Care

• Monitoring: Vital signs, oxygen saturation, ECG, urine output

• Pain Management: Epidural or systemic analgesia

• Respiratory Care: Incentive spirometry, physiotherapy, suctioning

• Complications to Watch:

  • Pneumothorax

  • Hemothorax

  • Infection

  • Arrhythmias

  • Cardiac tamponade

7. Nursing & Medical Student Focus

• Nursing: Chest drain care, pain management, respiratory exercises, monitoring hemodynamics, patient education.

• Medical Students: Recognize indications for surgery, monitor post-op complications, interpret imaging (CXR, CT), understand surgical anatomy and principles.

8. Cardiothoracic Mnemonics

• “ABC of Thoracic Drains”:

  • Air (pneumothorax)

  • Blood (hemothorax)

  • Chyle (chylothorax)

• “FAST” in Chest Trauma:

  • Fluid (hemothorax)

  • Air (pneumothorax)

  • Signs of shock

  • Thoracotomy if unstable

 Tables

Table 1: Common Cardiothoracic Procedures

Table 2: Post-Operative Monitoring for Cardiothoracic Surgery