Cardiothoracic Surgery
What the exam tests
This domain tests chest trauma, pneumothorax, haemothorax, cardiac tamponade, lung cancer staging and complications of thoracic and cardiac surgery.
Core rules
- Tension pneumothorax is a clinical diagnosis: needle decompression precedes chest imaging.
- A large haemothorax requires chest drainage and blood products; persistent bleeding may need thoracotomy.
- Cardiac tamponade shows Beck triad: hypotension, distended neck veins and muffled heart sounds. eFAST supports the diagnosis; pericardiocentesis or theatre is definitive.
- Lung cancer staging uses CT and PET-CT, with mediastinal sampling by EBUS or mediastinoscopy when indicated.
- After thoracotomy or cardiac surgery, monitor for atrial fibrillation, bleeding, air leak and respiratory failure.
Worked example
A 24-year-old has a stab wound to the left parasternal area. He is hypotensive with distended neck veins and muffled heart sounds. eFAST shows pericardial fluid. Pericardiocentesis is performed as a bridge, and he is transferred urgently to theatre for sternotomy and cardiac repair.
Traps
Waiting for a chest X-ray before decompressing a tension pneumothorax; missing rib fractures in an elderly patient with minor trauma; attributing hypotension to pain rather than tamponade; and failing to review chest drains for swinging, bubbling and blood loss.