New techniques and developments for pediatric emergency care

Various new techniques have been developed in recent years to improve the emergency management of children. Practice concepts have been tested for efficiency and unwanted effects in animal experiments and clinical studies. An electrical hand-held drill has been developed which allows rapid and efficient placement of an intraosseous vascular access. The early use of a laryngeal mask for airways in children who are difficult to ventilate with a bag and mask is now recommended in the current guidelines of the European Resuscitation Council for personnel trained in this method. The laryngeal tube (which is very effective and easy to place in adults) has been reported to be less efficient in children in these circumstances. The chest compression-ventilation ratio has been changed to 15:2 for children to achieve better training efficiency and better coronary perfusion. High dose adrenalin should not be used in the resuscitation of children. The application of hypothermia may be considered in children who remain comatose after resuscitation but the data are less clear in children than in adults, as its use in children has resulted in adverse outcomes and the cause and sequence of cardiac arrest differs between children and adults. Until further research can clarify the situation, a decision to use hypothermia must be made in an individualized manner. Decisive for the treatment of septic shock is the early and aggressive use of volume therapy.