This text is presented to all cardiothoracic surgery residents, attendings both present and future. This unique application, developed by residents and national faculty, is a 100-chapter compendium with an individual algorithm on various topics to provide a foundation and framework of important cardiothoracic surgery topics with clinical decisions. As the field of cardiothoracic surgery continues to evolve, attention to key clinical decisions is necessary prior to incorporating indicated interventions. Very few resources focus on the decision algorithms in the diagnosis and management of clinical cardiothoracic pathologies. The Thoracic Surgery Residents Association (TSRA) have a clear and sustained commitment to education. The previous textbooks created under the auspices of this organization are among the most affordable and practical manuscripts in our field. It is our hope to provide this addition to the growing TSRA library under the same tradition. Although this field is ever-changing, many of the basic principles remain the same: There are basic frameworks that are shared and can be used by those taking care of cardiothoracic patients. Very few resources focus on the decision algorithms in the diagnosis and management of clinical cardiothoracic pathologies.