Today we saw video of a 16 month old child who was seen for severe respiratory distress. Chest x-ray showed loops of bowel on the right side of the chest.

The discussion was very useful. Most of the clinical signs were picked up and presented. The loops of bowel in the chest x-ray were not commented on initially but later formed important point of discussion.

The learning points were:

• See the video till the end before coming to conclusions or shutting your mind.

• Diaphragmatic hernia or even eventrations can present late and need not be at birth

• Management plan mention important things first which will change how you provide care

• Chest x-ray, blood gases and other relevant investigations

• Blood gases: type one and type two respiratory failure were discussed.

• Read up on blood gases as a normal PCO2 in a child with tachypnoea needs urgent action

• The following phrases can guide the examiner to your discussion: The following phrases can guide the examiner to your discussion:

• Supportive care, safe intervention, relevant investigations.