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Thoracotomy is the surgical procedure with an incision made to access the pleural space and the contents of the thoracic cavity. Given the structures to be accessed with in the cavity, different incisions have been established to easy the procedure and these incisions qualify the types of thoracotomies to be studied hereunder. PRE OP OPTIMIZATION FOR SPECIFIC FACTORS The outcome of surgical procedures is not measured only by clinical end points but also shorter stays and lower costs. Patients’ discharge is delayed commonly due to inadequate pain relief, infection, arrhythmias, prolonged air leak and debility. Many complications that occur from thoracic operations can be anticipated. An aggressive preoperative work up mitigates morbidity and shortens convalescence. APPROACH CONSIDERATIONS There are about three principles that can guides the choice of the thoracotomy incision to be used I. Adequate exposure must be achieved. The choice of incision is aided by a thorough understanding of the surface anatomy and a comprehensive review of the radiographic images that are obtained preoperatively. II. Chest-wall function and appearance should be preserved to the extent possible. This principle include non-spreading video-assisted thoracoscopic surgery (VATS) procedures, muscle-sparing techniques, avoidance of excessive rib retraction, and rib preservation when possible. III. The third principle is that closure must be meticulous and appropriate. Strict layered closure is the rule for thoracic surgical incisions. Every effort should be made to approximate the individual divided chest-wall muscles in appropriate layers; otherwise, a significant delay in the recovery of range of motion (ROM) may result. Care must be taken to avoid over approximating the ribs and to prevent an override; this will help minimize postoperative pain. POST-OPERATIVE CARE AND MONITORING

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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of cardiac pumping: Learning objectives: 1. Discuss the significance of regulation of cardiac pumping 2. Discuss the concepts of preload and afterload 3. Discuss the mechanism and significance of Frank Starling’s Law 4. Discuss the intrinsic mechanisms of regulation of cardiac pumping 5. Discuss the effects of sympathetic and parasympathetic stimulation on the heart 6. Describe how serum potassium and calcium affect the heart function 7. Discuss the effect of body temperature on the heart function Study Resources: 1. Chapter 9, Guyton and Hall Textbook of Medical Physiology, 14th edition 2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition 3. Chapter 30, Ganong’s Review of Medical Physiology, 26th edition 4. Cardiac Cycle - StatPearls, https://www.ncbi.nlm.nih.gov/books/NBK459327/ 5. Chapter 14, Human Physiology An Integrated Approach, Dee Silverthorn, 8th ed

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Overview: Join Dr. Faiza in this in-depth lecture on cardiac impulse and the rhythmical excitation of the heart. This presentation covers the intricate pathways and mechanisms that ensure the efficient conduction of electrical impulses through the heart, leading to coordinated myocardial contractions. Attendees will gain a comprehensive understanding of the normal sequence of cardiac depolarization, the specialized conductive pathways, and the ionic basis of pacemaker potentials. Learning Objectives: Trace the normal sequence of cardiac depolarization via specialized conductive pathways and cardiac myocytes. Illustrate the velocity of conduction of cardiac impulses through these pathways. Draw and label a typical pacemaker action potential. Describe the ionic basis of various phases of the pacemaker potential. Key Topics: Generation of Impulse: Mechanisms of rhythmical excitation in the heart. Conduction of Impulse: How impulses are transmitted and why atrial syncytium contracts ahead of ventricular syncytium. Specialized Excitatory & Conductive System: Detailed examination of the SA node, AV node, bundle branches, and Purkinje fibers. SA Nodal Action Potential: Phases of pacemaker potential, ionic movements, and self-excitation mechanisms. Transmission Pathways: Role of anterior and posterior fascicles, internodal, and interatrial pathways. Clinical Significance: Implications of delayed conduction and conditions like Stokes-Adams syndrome and ectopic pacemakers. Target Audience: This lecture is tailored for medical students, physiology scholars, healthcare professionals, and anyone interested in cardiac physiology and the mechanisms of cardiac impulse conduction. It is particularly beneficial for those preparing for exams or seeking to enhance their clinical knowledge in Applied physiology of cardiovascular system and internal medicine.

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