The MGH PICU is a busy 14 bed pediatric referral center. The goal of the PICU rotation is to develop the ability of junior residents to evaluate and manage critically ill children with a broad range of medical and surgical problems. Residents, acting as the primary caregiver under close attending and fellow supervision, are exposed to CPR, ECMO, invasive ICP monitoring, shock, mechanical ventilation, critically ill post op patients, sedation, and analgesia. Residents gain experience in diagnostic and therapeutic procedures such as IV placement, ABGs, bag mask ventilation, central lines, endotracheal intubation, and thoracentesis. Our PICU draws from a wide range of patient populations, providing exposure to many patients with rare or multi-organ system disease. In addition to transfers from several local community hospitals, patients from Mass Eye and Ear Infirmary are admitted to the PICU for post-op management after many complicated airway reconstruction procedures. In addition residents assist in stabilization and management of many children admitted through our active trauma service.