Trick of the Trade: Prescribing opiates

PrescriptionPadAs emergency physicians, we are experts in pain control. We frequently write opiate prescriptions for patients being discharged home. Unfortunately, an occasional patient tries to forge my prescription. At times, I get a call from pharmacy for prescriptions that were suspiciously written. For instance several years ago, I had someone try to forge 100 tablets of “Mophine”.


By |2016-11-11T19:00:35-08:00Aug 4, 2010|Tox & Medications, Tricks of the Trade|

Trick of the Trade: A tongue blade is as mighty as an xray

Patients often present to the Emergency Department for mandibular blunt trauma. Usually these patients have soft tissue swelling at the point of impact. In mandibular body fractures, the fracture line often extends to the alevolar ridge. This may cause a gap between a pair of lower teeth.

In patients with jaw pain, mild swelling, and normal dentition, is there a way to avoid imaging these patients to rule-out a mandible fracture?


By |2016-11-11T19:00:37-08:00Jul 21, 2010|ENT, Tricks of the Trade|

Trick of the Trade: OKN drum to test psychogenic coma

3D Character and Question MarkOccasionally, emergency physicians see patients who present because they are unresponsive despite normal vital signs and an otherwise normal exam. You detect no drugs or alcohol on board. You suspect a psychiatric or malingering etiology, but aren’t sure. They seem non-responsive to voice and minimally responsive to very painful stimuli. Is this a case of psychogenic coma or true coma (with bilateral hemispheric dysfunction)?

What test can you do to reassure yourself that this may indeed be psychogenic coma?


By |2019-01-28T23:37:29-08:00Jul 14, 2010|Neurology, Tricks of the Trade|

Work NOT in progress: ACEP Tricks of the Trade column

3d puppet with a penSince 2006, I have been the ACEP News columnist on “Tricks of the Trade in Emergency Medicine. Four years later, I’ve published and co-published 33 articles on various both low-tech and high-tech pearls.

It’s official — I’ll be stepping down from the ACEP News columnist position and handing off the reins to someone with fresher ideas. Frankly, I’m running out of innovative ideas worth publishing about.


By |2016-11-11T19:00:39-08:00Jul 6, 2010|Tricks of the Trade|