Journal of accident & emergency medicine
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The organisation of the American emergency health care system has changed rapidly during recent years, but it remains very different to the system in the United Kingdom. American emergency departments are organised around an attending physician based service, rather than a consultant led service. ⋯ The problems associated with working in an attending physician based service include antisocial hours of work, sleep deprivation, decreased job satisfaction, and "burn out," all in the context of a relatively hostile medicolegal climate. Although there appear to be no easy answers to some of these problems, the A&E specialist should be aware of the potential future difficulties for A&E medicine as it develops within the United Kingdom.
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Review Comparative Study
A transatlantic comparison of training in emergency medicine.
The system of training in accident and emergency (A&E) medicine in the United Kingdom is at a critical and much earlier stage of development than in the United States. Transatlantic comparison offers the opportunity to explore possible ways of improving training in the United Kingdom. Comparison revealed deficiencies in the UK training system in the following: prehospital care training, formal theoretical teaching, close supervision in a clinical setting, and in-service training examinations. Implementation of measures designed to address these deficiencies would enhance UK training in A&E medicine.
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A case of stone heart syndrome is reported in a pregnant 27 year old West African patient, who suffered syncopal symptoms shortly before cardiac arrest. The electrocardiographic features were those of asystole, but direct examination of the heart at emergency thoracotomy in the A&E department revealed tetanic contracture of the organ. At necropsy, the heart was of normal weight but showed areas of fibrosis surrounding the bundle of His. The discrepancy between the ECG features and the physiological state of the heart raises the possibility that other cases of apparent asystole may not be what they seem.