PICU Resident Course Participants will recognize and respond to pediatric intensive care situations in a simulated PICU environment. Participants will demonstrate and build knowledge of pediatric critical care and perform of advanced skills including intraosseous placement, intubation, and airway management Simulation experiences will conclude with debriefing and discussion of teaching points. Debriefing staff includes pediatric experts in critical care and emergency medicine. Audiovisual recordings may be utilized for debriefing sessions to promote effective debriefing and provide constructive feedback to participants. Objectives 1. Prompt recognition and intervention in pediatric crises. 2. Apply advanced treatment rationales in pediatric crises. 3. Order, analyze and respond to appropriate laboratory data 4. Identify and administer pediatric pharmacology interventions in various simulations 5. Discuss and demonstrate advanced knowledge of pediatric crises 6. Demonstrate specialist pediatric manual skills such as pediatric resuscitation, intraosseous placement, intubation 7. Demonstrate team leadership in pediatric crises 8. Communicate and plan with team members. 9. Develop a plan for supportive care Frequency Offered weekly during monthly PICU rotation Participants: 3-4 per session. Open to PGY Residents 2, 3. Cases May Include Septic Shock Cardiogenic Shock Tricyclic Antidepressant Overdose Trauma Resuscitation Airway obstruction Respiratory distress Respiratory arrest Cardiopulmonary arrest Status epilepticus Increased intracranial pressure Nonaccidental trauma Rhythm disturbances (bradycardia, SVT, PEA, asystole ventricular tachycardia, ventricular fibrillation) Altered mental status Resources Blumberg, S.M., Gorn, M., and Crain, E. F. Intraosseous infusion a review of methods and novel devices. Pediatric Emergency Care. 2008; 24;50-59. Michael, J.B., Sztajnkrycer, M.D. Deadly pediatric poisons: nine common agents that kill at low doses. Emerg Med Clin N Am. 2004:22; 1019-1050. Supplies Advanced Airway supplies Resuscitation Cart Defibrillator IV access supplies Emergency drugs SimBaby SimMan PediaSim