Introduction: The External Jugular Vein is superficial with a wide caliber and is also isolated from major neurovascular structures in neck. It can be simply cannulatedand used for fluid and inotrope administration without any major complications. Objectives: The goal of our retrospective pilot study is to demonstrate the feasibility of External Jugular Vein (EJV) access in the pediatric population in emergency settings. Methods: A total of seventy five childrenwere retrospectively evaluated after EJV cannulation. Results: EJV cannulation was successful in 63 children (84%) at the first attempt while 12 children (16%) required more than one attempt. All patients received vasoactive agents through the EJVcannula. Nineteen (25.33%) children had EJV cannulation related complications. Conclusions: As per our observations in this pilot study, vasoactive agents and intravenous fluids for resuscitation can be safely infused through the EJV in majority of children without any major complications. This route of administration could be considered especially in emergency and resource poor settings.

Pulmonary alveolar Proteinosis (PAP) is a rare disease whereby the alveolar sacs are filled with a lipoproteinaceous material. The accumulation of this material hinders gas exchange, resulting in a variety of presentations involving all age groups. Symptoms range in severity from mild cough and dyspnea in most patients, to respiratory distress and failure to thrive in infants and young children. Depending on the etiology, PAP cases are classified as being hereditary, secondary, or autoimmune. Despite the different mechanisms underlying these, a unifying pathophysiological concept for PAP exists. Diagnosis is often difficult, and takes time to establish, given the vague nature ofthe presenting symptoms ofthis disease. High resolution computed tomography (HRCT) remains the preferred radiological diagnostic tool. Diagnosis is confirmed by lung biopsy and bronchoalveolar fluid lavage. Management encompasses whole lung lavage (WLL), exogenous GM-CSF therapy, supportive respiratory measures where necessary, and even lung transplant in some severe cases. Children affected with PAP remain a population with high mortality. Pediatric literature is scarce in comparison to PAP described in adults. This paper focuses on reviewing the pathophysiology in context to recent advances in molecular genetics, diagnosis, and management in children with this disease.

Simulation offers tremendous promise to improve health care delivery especially in acute care areas. It can be an efficient mode to learn, probe and improve crisis resource management, unit risk assessment, establish an environment for discussing error without punishment, investigating human performance, assessing situation readiness, implement new protocols, test run new instruments, improve interdepartmental coordination, learn new concepts or procedural skills and also in establishing systems and usability of a new unit. Simulation based learning relies heavily on reflective practice, a key foundational concept of adult learning. PediSTARS India is actively working towards addressing the challenges of implementing simulation based interventions to better the care of sick children in India.

Pediatric Advanced Life Support (PALS) course is a very popular course directed towards Pediatricians aimed towards improving the outcomes of sick children. However, despite the popularity of the course, translation of this knowledge to the bedside has been far from satisfactory due to variety of reasons. Few strategies have been employed to make the course more effective. Modular training by delivering PALS components in a staggered fashion over a defined time period, self-directed interactive web based learning, use of high fidelity simulators to deliver realistic scenarios, conducting the course in the provider’s workplace using his resources and team and using reflective practice based debriefing technique to enhance learning from real life events have shown some promise.

Emergency Department and Pediatric intensive care units are acute Pediatric care areas with high risk and require quality and safe care to deliver good outcomes to children. Simulation appears to be adapted well in many Emergency Departments as well as PICUs across the world to understand and optimise the delivery of acute care. We have little data on the adaptability and application of simulation methods into acute Pediatric care provision in India. Simulation is currently limited to a few task-training workshops and is yet to become an integral part of healthcare in day-to-day practice. There is a lot of room to expand the scope of simulation in Emergency Departments and PICUs across the country. There is a need to expand the expertise and numbers of simulation trainers to facilitate the wider application. Further studies are needed to understand the impact on patient outcomes and understand the challenges in wider application to patient care.

Appropriate management of neonatal emergencies not only requires knowledge and skills but also effective teamwork. Adults are experiential learners who learn by reflecting on the clinical situation they were involved with. Simulation is an effective tool to train as a team and also learn by reflection in a safe environment. Simulation brings out the human factors, which significantly contributes to medical errors and helps train in crisis resource management. Simulation based training is now recommended by resuscitation councils worldwide. In neonatal training, simulation can be used as a tool in many contexts - learning psychomotor skills, identifying knowledge gaps, communication skills and teamwork. In situ simulation will also help test the systems. We describe some key contexts wherein simulation based training can be used effectively as a tool to improve clinical care and enhance quality in neonatal medicine.

Debriefing is a critical part of a simulation exercise in order to foster reflection and enhance clinical reasoning. Without a proper understanding of how to debrief simulation based trainings or real life events can be ineffective and inconsistent. In this article we provide an overview to the necessary elements of debriefing. We describe a three-stage approach to debriefing; reactions, descriptive and summary and review different forms of questioning that can be used in the descriptive phase. It is important for educators in simulation to train and understand how to effectively lead learners through simulation and debriefing in order to be successful.

Medical education has increasingly focused on patient safety in the last few decades. Awareness of and emphasis on adult learning principles have made simulation training a novel method. Creating a realistic case scenario experience is very important for the active engagement ofthe participant to facilitate reflection during debriefing. Designing a simulation session in order to recreate a realistic clinical experience requires rigorous research and meticulous planning. Poor preparation may cause the whole experience of simulation to be counter-productive. These insights are simplified into a step by step approach in this article where the importance of a thorough Needs-Assessment, clear aims, SMART learning Objectives and a well-designed scenario is elucidated thus demystifying the intricate process of planning a simulation session.

Paraquat is a broad spectrum liquid herbicide associated with both accidental and intentional ingestion, leading to severe and often fatal toxicity. There are no clear cut guidelines for the management of Paraquat poisoning and the treatment is usually supportive. Newer treatment options such as immune modulation, hemodialysis, hemoperfusion and antioxidant therapy are being practiced in some centers. We present a case of 9 year old female child with paraquat ingestion with review of literature on its management.

Fanconi-Bickel syndrome (FBS) is an example of proximal Renal tubular dysfunction due to a single gene disorder, it is caused by defects in the facilitative glucose transporter 2 gene that codes for the glucose transporter protein 2 expressed in hepatocytes, pancreatic β-cells, enterocytes and renal tubular cells. It is a rare inherited disorder of carbohydrate metabolism manifested by failure to thrive, hepatomegaly, severe hypophosphatemic rickets and proximal renal tubular dysfunction. We present case of Fanconi-Bickel syndrome, a rare type of glycogen storage disease type XI whose incidence is unknown but less than 200 cases have been reported since 1949.

Wegener’s granulomatosis is an uncommon autoimmue disease with multi-system involvement, characterized by necrotizing granulomatous inflammation of the upper and lower respiratory tracts and general focal necrotizing vasculitis (Commonly known as Wegener’s triad). The lungs are involved in 72 percents of patients and the clinical and radiographic findings indicate bilateral pulmonary nodules of varying size and definition, cavitated in half of the patients, accompanied by the nodular lesion with rare involvement of the pleura. We present a case in 4 year old male child presenting with symptoms of recurrent airway disease and chronic sinusitis with detection of lung lesions on further investigations and pathological confirmation by antineutrophil cytoplasmic antibody positivity and based on radiological and clinical suspicion.

Objective: To present clinical experience and outcome of severe hepatic-neurological complications of dengue fever. Methods: From August to November 2015, all confirmed dengue cases admitted to Pediatric intensive care unit(PICU) were studied and data was retrospectively collected and analyzed. Results: Out of196 confirmed dengue cases 11 had severe hepatic-neurological complications Neurological complications were seen in 7 patients of which 2 had meningoencephalitis, 2 had meningitis and 3 had seizures. All recovered completely except one who had sequelae. Acute liver failure occurred in 4 and 3 recovered completely except one who expired. Conclusions: Use of N-acetylcysteine in ALF is found to be beneficial. In our experience outcome of these complications is good, however larger trials are needed to investigate further.