A 7 year old child with a history of cough and fever for 1 week, has bronchial breathing over her left lower zone on auscultation. A diagnosis of lobar pneumonia is made, confirmed on plain chest x-ray, and she is treated with appropriate intravenous antibiotics. However, she continues to have a spiking fever and develops signs of a left sided pleural effusion. Repeat chest x-ray shows a ‘white out’ of the left chest with no mediastinal shift. She is referred to the regional thoracic centre for consideration of thoracotomy and drainage of a left sided parapneumonic effusion. Should she be referred to the surgeons and if so, what should they do?

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A 720g neonate in the intensive care unit develops severe hyperkalaemia with cardiac arrhythmia. The Specialist registrar decides to give a Calcium Gluconate bolus and start an Insulin and Dextrose infusion. The new Registrar queries why Salbutamol and Ion Exchange resins were not considered as these therapies are frequently used in management of hyperkalaemia in older children and adults. more…