The International Life Saving Federation urgently reminds all would-be rescuers that handsonly CPR is not appropriate in cases of drowning. The American Heart Association (AHA) Emergency Cardiovascular Care (ECC) Committee has recently published a statement on cardiopulmonary resuscitation (CPR). (1) This recommends that bystanders who witness an adult suddenly collapsing out of hospital should perform chest compressions only without giving mouth-to-mouth ventilation, so-called hands-only CPR. Drowning is the second leading cause of accidental death worldwide. While hands-only CPR may be effective in cases of sudden heart attack, cardiac arrest during drowning is due, in large part, to lack of oxygen. The body is thus starved of oxygen and needs urgent replenishment in addition to circulation of blood that is provided by chest compressions. Similarly, compres sion-only CPR is inappropriate in cases of cardiac arrest in children, when failure of breathing is the usual underlying cause.

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We found that a high degree of burnout exists in pediatric critical care medicine, with 50% of pediatric intensivists at risk or burned out. Overall, there was no association between Burnout Scores and training, practice specialties, or practice settings, nor was there an association with aspects of practice that are physically taxing. However, perceptions about the value of their work and feelings of success and satisfaction were highly associated with those respondents classified as burned out. Routine exercise (a strategy used by some for stress reduction) was associated with lower Burnout Scores. Further studies are necessary to evaluate the trends that we have reported and to identify causal factors.

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Ethics consultations are used by doctors who believe in shared decision making. Doctors who did not use ethics consultation tended to think that it was their responsibility to resolve issues with patients and families and that they were already proficient in ethics.