Introduction: Pediatric Intensive Care training is an integral part of Pediatric Postgraduate Program with scant data in the published literature on student’s perception about training in Pediatric intensive care (PICU). We undertook this student (resident) survey to study the perception and prevalent opinion regarding the current status of PICU training in southern India. Methods: 100 Pediatric residents of various institutions of South India with > 3 months of PICU training were asked to respond to a set questionnaire by e mail, on line over a one year period. All residents who participated in ventilation workshop, conducted at SRMC and RI(Sri Ramachandra medical college and Rajiv Gandhi institute) during 2014 and 2015, were selected for the survey. Residents with PICU training of less than 3 months were not included in the study. Response of the 45 residents was finally put to analysis who responded with answering all questions during the survey. Results: 55 % of the residents felt PICU posting was stressful. Regarding total duration of PICU posting 57% residents thought 6 months and 33% thought 8 months are required during post graduation. Only 77% were confident in recognising and managing critical care illness independently at the end of postgraduate training. 91% thought that undergoing BLS (Basic life support) and PALS (Pediatric advanced life support) training prior to PICU posting should be mandatory. Only 71% participated in Simulation Based Learning Programmes during post graduation. Conclusion: All 45 residents felt that PICU training, though stressful, was interesting, increased the overall confidence and was very much needed as part of their post graduate training. Majority felt that undergoing BLS (Basic life support) and PALS (Pediatric advanced life support) training prior to PICU posting should be mandatory.

Acute poisoning in children is common problem worldwide, prevalent in rural as well as urban areas. Exposure of a child to such a substance is usually accidental and can cause symptoms and signs of organ dysfunction leading to injury or death. This review is intended to discuss general approach to various types of accidental poisoning based on altered physiology in general and history and a physical examination with intent to fit the clinical characteristics into a group of signs and symptoms associated with a particular substance. (also known as TOXIDROMES) Fortunately, very few patients require hospital admission and even fewer patients need treatment in a pediatric Intensive care unit. Most patients will need a period of observation in a monitored bed which could be located in the emergency ward or in a step down level of pediatric intensive care unit The ones who need admission to pediatric intensive care unit are usually critical if organ dysfunction sets in. The challenge to the pediatric Intensivist tends to be institution of supportive treatment promptly, as well as, to institute specific antedote therapy (if available) as soon as feasible. To the physician examining the patient a challenging issue is to determine which ingestions are potentially high risk and which are Inconsequential. Alluminium phosphide, organophosphorous compounds, kerosens oil ingestion can result in life threatening problems in affected children, are therefore reviewed in greater detail. Most poisonings can be managed by supportive treatment in the PICU.

Foreign body aspiration in children commonly presents with coughing, dyspnea, wheezing, cyanosis and stridor. Our case presented with cardio-respiratory arrest (CRA), and was successfully revived, but suffered recurrent CRA, and finally betel nut was retrieved from the airway. Here clinical course of the patient favours migration of foreign body leading to recurrent cardio-respiratory arrest. Foreign body migration in airway is an unusual phenomenon, and its presentation as recurrent cardio-respiratory arrest is very rare.

Staphylococcal toxic shock syndrome (TSS) is a rare and potentially fatal multi system dysfunction. The syndrome occurs primarily due to TSS Toxin-1 (TSS-1) liberated by Staphylococcus aureus (SA). Fever with rash followed by multi organ dysfunction in the form of acute kidney injury, raised liver transaminases and refractory hypotension indicates the possible diagnosis of a TSS, more commonly by Staphylococcus. Here, a 7 year old boy presented with all the features of toxic shock syndrome, developed hyponatremia, hyperkalemia, refractory hypoglycaemia and hypotension and succumbed within 12 hours of admission and ultimately was diagnosed to be a case of Staphylococcal toxic shock syndrome due to MSSA with Waterhouse Friderichsen Syndrome (WFS).

Cardiovascular complications are known to occur during dengue fever including both tachyarrhythmias and bradyarrythmias. We report a case of 15 year old boy with severe dengue fever who had rhythm disturbance showing a 2:1 heart block with hemodynamic instability during acute phase of illness. The child responded to atropine and did not require any further intervention requiring a pacemaker.

Acute intermittent porphyria is an inherited metabolic disease due to deficiency of the enzyme porphobilinogen deaminase that can affect the autonomic, peripheral and central nervous system. We report an 8 year old female who had presented with hyponatremia, psychiatric manifestations, seizures, hypertension and Posterior Reversible Encephalopathy Syndrome (PRES) with a delayed diagnosis of Acute Intermittent Porphyria. As porphyria is thought to be very rare in pre-pubertal age, in view of the potentially fatal outcome of a severe attack, a high index of suspicion is essential.

The Landau-Kleffner syndrome or the syndrome of acquired epileptic aphasia was first described in 1957. The disorder is characterized by gradual or rapid loss of language in a previously normal child. Acquired epileptic aphasia (AEA) typically develops in healthy children who acutely or progressively lose receptive and expressive language ability coincident with the appearance of paroxysmal electroencephalographs (EEG) changes. In most cases described in detail, a clearly normal period of motor and language development occurs before acquired epileptic aphasia symptoms appear. Because this syndrome appears during such a critical period of language acquisition in a child’s life, speech production may be affected just as severely as language comprehension. The onset of LKS is typically between 18 months and 13 years. The prevalence of clinical seizures in acquired epileptic aphasia (LKS) is 70-85%. The syndrome can be difficult to diagnose and may be misdiagnosed as autism, pervasive developmental disorder, hearing impairment, learning disability, auditory/ verbal processing disorder, attention deficit disorder, intellectual disability, childhood schizophrenia, or emotional/behavioural problems. An EEG (electroencephalogram) test is imperative to a diagnosis.