Work-related Fatigue, Stress and Depression of the Emergency Department Interns

PURPOSE: An internship is a very generally a stressful period during medical training in general. Working in the Emergency Department (ED) is especially difficult and stressful because of its unique clinical environment. Our goal was to determine the level of the depression, fatigue, sleep disorders and stress of interns in the ED. METHODS: A questionnaire was distributed to 430 interns who are working or had worked in the ED. The questionnaire included questions about general characteristics and scales relating to symptoms of depression, fatigue, sleep disorder and stress. RESULTS: Of the 430 questionnaires given out, 178(41.4%) were returned. The mean age of the participants was 28.4+/-2.9, and 123(69.5%) were male. Also, 112(63.3%) participants were working at an alumni-affiliated hospital or at related hospital. The interns at an unrelated hospital experienced more discrimination than those working at an alumni-related hospital (21.5% vs. 9.8%, respectively, p=0.031). Also, female interns experienced more sexual harassment than male interns (16.7% vs. 2.4%, respectively, p=0.001). The average score for medical outcomes study MOS sleep scale, Beck Depression Inventory, Fatigue Severity Scale and Cohen Perceived Stress Scale were 16.2+/-4.0, 8.0+/-7.8, 4.3+/-1.2 and 19.4+/-5.4, respectively. The degree of participation in treating patients first hand (OR 2.33, 95% CI=1.19-4.57), experiencing discrimination (OR 3.17, 95% CI=1.15-8.73) and long working hours (OR 2.02, 95% CI=1.05-3.86) had a significant effect on stress and depression. CONCLUSION: The interns who worked at an ED had higher fatigue and stress scores compared to ordinary person. Also, participation, discrimination and working hours may be good to mention. Therefore, more research and effort is required to improve the factors that cause fatigue, stress and depression of the interns in ED.

Influence of Multiple Rib Fracture upon Traumatic Hemo-pneumothorax

PURPOSE: Multiple rib fracture (MRF) and a hemopneumothorax accompany with most blunt chest traumas. We aimed to analyze the factors increasing the probability of a hemopneumothorax. In addition, other injuries accompanying MRF were analyzed. METHODS: We retrospectively reviewed the medical records of 154 mutiple rib fracture patients who visited our hospital between January 2005 and December 2007. The medical records were reviewed for sex, age, mechanism of injury, location, number of fractures, distance of dislocated rib fragments, and presence of complications. We measured the distance of bony dislocations by using the PACS (Picture Archiving and Communication System). RESULTS: The average number of rib fractures was 3.7+/-2.1, and the number of rib fractures significantly influenced the incidence of a hemothorax (p<0.001). The risk of a phemothorax was increased in a bilateral MRF compared to a unilateral MRF (p=0.027). The distance of dislocated rib fragments influenced the probability of a hemothorax significantly (p=0.018), and subcutaneous emphysema and lung contusion were significantly associated with a pneumothorax (p=0.021, p=0.036). CONCLUSION: The number of MRFs did not influence the risk for a pneumothorax, but did influence the risk for a hemothorax. The laterality, distance of dislocation, also had an influence on the risk for a hemothorax. Also, subcutaneous emphysema and lung contusion were increased in cases with a pneumothorax. We must consider the possibility of a hemothorax even when the initial chest X-ray shows no evidence of a hemothorax. If a lung contusion is present, then an occult pneumothorax must be considered.