Nutrition practice in burn injury requires a multifaceted approach aimed at providing meta-bolic support during a heightened inflammatory state,while accommodating surgical and medical needs of the patient. Nutritional assessment and determination of nutrient requirements are difficult,particularly given the metabolic disarray that frequently accompanies inflammation. Nutritional therapy requires careful decision making,regarding the safe use of enteral or parenteral nutrition and the aggressiveness of nutrient delivery given the severity of the patient′s illness and response to treatment.

Metabolic crises caused by inborn errors of metabolism are not rare.Its clinical manifestations are non-specific.Clinicians generally have a tendency to pursue this possibility only after other more common conditions have been excluded.If prompt treatment is not initiated early,the patients may deteriorated rapidly,even death may occurs over hours to days.The survivors may have severe sequelae.Diagnosis of metabolic crisis caused by inborn errors of metabolism does not require extensive knowledge of biochemical metabolic pathways or individual metabolic diseases.It is most important to have an intimate knowledge of the major manifestations and initial laboratory tests features that may suggest the diagnosis clues.An early diagnosis and institution of appropriate therapy is often life saving and can prevent permanent neurologic sequelae.

Fatal arrhythmias are much less common in children than adults and the symptoms presented may be nonspecific.The critical rescue measures for these patients are to identify and appropriately manage the arrhythmias,since when left untreated,arrhythmias may lead to cardiopulmonary compromise and arrest.Most children with a fatal arrhythmia present to a emergency physician before being referred to a pediatric cardiologist for assessment and management.Thus,the emergency pediatricians have to be able to recognize the fatal arrhythmia and to provide the acute treatment.This article was intended to provide diagnostic and acute management measures of the common types of fatal arrhythmias seen in children.

Intravenous lipid emulsions( LEs) are relevant for patients receiving parenteral nutrition because they prevent the depletion of essential fatty acids(FAs) and as a highly dense energy source. The prescription of LEs is complex,due mainly to their distinct FAs components,which may alter the immune re-sponse in different ways and distinctly influence inflammation according to their biochemical properties. The patient′s metabolic profile should guide the type of FAs and amount of lipids that are provided. For critically ill hypermetabolic patients,growing evidence indicates that standard LEs based solely on soybean oil should be avoided in favor of new LEs containing medium-chain triglycerides,olive oil,or fish oil to decrease the provision of potentially inflammatory/immunosuppressiveω-6 polyunsaturated fatty acids. As sources of eico-sapentaenoic and docosahexaenoic acids,LEs containing fish oil may be important for critically ill patients be-cause they allow better modulation of the immune response and likely reduce the length of intensive care unit stay. However,current evidence precludes the recommendation of a specific LE for clinical use in this patient population.

In Oct 2010,American Heart Association (AHA) released new guidelines for pediatric basic life support and pediatric advanced life support.The new AHA guidelines are based on an extensive review of thousands of resuscitation studies by experts who reached a consensus over a 3-year period.Compared with the 2005 AHA guidelines for pediatric basic and advanced life support,the new guidelines made major changes on some key issues,including the change of basic life sequence from A-B-C to C-A-B,high-quality chest compression,defibrillation and the use of automated external defibrillator in infants,medications during resuscitation,resuscitation of children with congenital heart disease,post-resuscitation management and evaluation of sudden cardiac death victims.This paper summarized the substantial changes and the reasons to change.

Nutrition support,including parenteral nutrition and enteral nutrition,has been one of the important treatment for critical illness in children.The risk of nutrition support attracts more and more attention.The complications of nutrition support include nutrition support access associated mechanical injuries,catheter related bloodstream infection,enteral nutrition intolerance and metabolic complications.Most of these complications are preventable.The most effective prevention is evaluating and controlling the risk factors.Prevention and treatment of the complications is the key of successful nutrition support and improving the prognosis.

Mycoplasma pneumoniae (MP) is the most common pathogens of community-acquired pneumonia in children.Macrolides are the first-line antibiotics for mycoplasma pneumoniae pneumonia (MPP) treatment.However, in recent years, with macrolide resistant MP (MRMP) becoming prevalent, refractory MPP (RMPP) and fulminant MPP (FMPP) increased significantly.It has become a hot issue for clinicians.This paper reviewed the recent studies on MRMP, RMPP and FMPP, discussed the diagnosis and treatment options for MRMP, RMPP and FMPP in detail.Prioritizing the selection of sensitive antibiotics and early initiation of effective antibiotic therapy, appropriate use of immunoregulatory and anti-inflammatory therapies, and aggressive treatment of complications and co-infections are the keys to RMPP and FMPP therapy.

Objective To assess the effect of scene simulation-based teaching on pediatric advanced life support(PALS)skills in medical students.Methods The students of two grades of Department of Pedi-atrics in Capital Medical University participated in the PALS training.All of them had the examination of the-ory and skills of critical illness management and cardiopulmonary resuscitation in children before and after the scene simulation-based teaching on PALS.The questionnaire was filled out and the data was analyzed after the training.Results Fifty-one students completed the training.The average score after the training was sig-nificantly higher than that before the training(86.51 ±7.16 vs.53.85 ±14.24,P ﹤0.05).After the training, the error rate of ECG recognition,etiological identification and treatment of the disease,and the dosage as well as usage of medicine was significantly decreased (64.7% vs.15.7%,71.0% vs.10.5%,73.2%vs.25.9%).All of the students could use the defibrillator correctly and the students'satisfaction rate was more than 94%.Conclusion Scene simulation-based teaching on PALS skills can improve the theory and skills of critical illness management and cardiopulmonary resuscitation of children in medical students.

Traumatic injuries are the most common cause of children death and disability in the world. Trauma resuscitation is a complex and dynamic process that is best managed by experienced,highly trained teams. Advanced trauma life support(ATLS) course is the most broadly disseminated and recognized training program for the initial assessment,stabilization and management of the injured patient worldwide. Pe-diatric trauma life support(PTLS) is the section of ATLS on emergency management of childhood trauma. ATLS course provided a standardized approach to the care of critically injured patients. It introduced the air-way(A)-breathing(B)-circulation(C)-disability(D)-exposure(E) sequence of initial evaluation to trauma care and highlighting the importance of a team approach. When resuscitation efforts are well established,and the vital signs are normalizing or improving,the secondary survey can be conducted. The secondary survey is a head-to-toe evaluation of the trauma patient,including a complete history,physical examination,and the reassessment of all vital signs. The ATLS and PTLS systematic evaluation is designed to help clinicians focus on life-threatening problems and minimize the risk of missed injuries.

Thrombotic thrombocytopenic purpura (TTP) is a rare but fatal entity of thrombotic microangiopathies(TMAs).The pathophysiology of the disease is based on a severe functional deficiency of a disintegrin and metalloprotease with thrombospondin type 1 repeats,member 13 (ADAMTS-13),the specific von Willebrand factor (VWF)-cleavage protease.This deficiency may be either acquired or congenital.The clinical manifestations of TTP include microangiopathic hemolytic anemia,thrombocytopenia and dysfunction of involved organs,which are similar to other TMAs.The differential diagnosis with other TMAs may be challenging.The activity of plasma ADAMTS-13 ＜ 10％ is the only definitive method for diagnosis of TTP.The first-line treatment of the acute phase of TTP is based on plasmatherapy.In congenital TTP,patients benefit from a prophylactic plasmatherapy.In acquired TTP,steroids and B-cells depleting therapies are increasingly used together with plasma exchange.Long-term follow-up including the monitoring of ADAMTS-13 activity is mandatory.A severe decrease in ADAMTS-13 activity (＜ 10％) may predict relapses and preemptive B-cell depletion with rituximab can be used to prevent relapses of acquired TTP.