BACKGROUND:Abdominal pain is a top chief complaint of patients presenting to Emergency Departments (ED). Historically, uncertainty surrounded correct management. Evidence has shown adequate analgesia does not obscure the diagnosis, making it the standard of care.OBJECTIVE:We sought to evaluate trends in treatment of abdominal pain in an academic ED during a 10-year period.METHODS:We prospectively evaluated a convenience sample of patients in an urban academic tertiary care hospital ED from September 2000 through April 2010. Adult patients presenting with a chief complaint of abdominal pain were included in this study. Analgesic administration rates and times, pain scores, and patient satisfaction at discharge were analyzed to evaluate trends by year.RESULTS:There were 2,646 patients presenting with abdominal pain who were enrolled during the study period. Rates of analgesic administration generally increased each year from 39.9% in 2000 to 65.5% in 2010 (p value for trend <0.001). Similarly, time to analgesic administration generally decreased by year, from 116 min in 2000 to 81 min in 2009 (p < 0.001). There was no improvement in mean pain scores at discharge by year (p = 0.27) and 48% of patients during the 10-year period still reported moderate to severe pain at discharge. Patient satisfaction with pain treatment increased from a score of 7.1 to 9.0 during the study period (p < 0.005), following the trend of increase in analgesic administration.CONCLUSIONS:In patients presenting to the ED with abdominal pain, analgesia administration increased and time to medication decreased during the 10-year period. Despite overall improvements in satisfaction, significant numbers of patients presenting with abdominal pain still reported moderate to severe pain at discharge.

Catamenial pneumothorax (CP) is defined as recurrent spontaneous pneumothorax occurring within 72 hours before or after onset of menstruation. The aetiology of this syndrome is unknown, although many theories have been proposed to explain it. A 43-year-old female presented to our emergency room with a complaint of left sided chest pain. She had no dyspnoea or haemoptysis during the admission. She had a history of pelvic endometriosis without any complaints for three years. Pneumothorax or pneumonia was not detected on chest X-ray. Blood tests and electrocardiogram findings did not support any cardiac or infectious cause. Computed tomography showed a pneumothorax on the mediastinal side of left hemithorax. The patient was referred to a thoracic surgeon. A thoracoscopy for histological confirmation was performed and the diagnosis of CP was made with a histological intervention.

OBJECTIVE:To determine the effects of a communication skills training program on emergency nurses and patient satisfaction.METHODS:Sixteen emergency nurses attended a 6-week psychoeducation program that was intended to improve their communication skills. The first 3 sessions of the psychoeducation program consisted of theoretical education on empathy and communication. Other sessions covered awareness, active communication, and empathic skills on a cognitive behavioral basis using discussion, role play, and homework within an interactive group. The effects of the program were assessed using a communication skills scale, empathy scale, and patient satisfaction survey and were reflected by the reduction in the number of undesirable events between nurses and patients in the emergency department.RESULTS:The mean communication skill score (177.8±20) increased to 198.8±15 after training (p=0.001). Empathy score also increased from 25.7±7 to 32.6±6 (p=0.001). The patient satisfaction survey of 429 patients demonstrated increased scores on confidence in the nurses (76.4±11.2 to 84.6±8.3; p=0.01); the nurse's respect, kindness, and thoughtfulness (72.2± 8.1 to 82.1 ± 6,5; p=0.01); individualized attention (71.3± 6.2 to 73.2 ± 9.8; p=0.2); devotion of adequate time to listening (84.6± 9.3 to 89.8 ± 7.6; p=0.03); and counseling and information delivery (71.1± 10.2 to 80.2 ± 9.7; p=0.01). The number of undesirable events and complaints during nurse-patient interactions decreased 66 % from 6 to 2.CONCLUSION:"Communication Skills Training" can improve emergency nurses' communication and empathy skills with a corresponding increase in patient satisfaction and reduction of the undesirable events and complaints during nurse-patient interactions.