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Dear allWe are currently putting together a national guideline for the ED management of fractured NOF in Ireland. Not wishing to re-invent the wheel, we have been borrowing extensively from both the NICE and SIGN guidelines. Some pain management issues nevertheless require some clarification which I would be grateful for your thoughts and reflections on! 1. NICE does not clarify initial dosages for the admin of opioids. Reading the following articles from anaesthesiology had some interesting insights but was nevertheless in a post-op, PACU setting with close monitoring and small nurse to pt ratios. Unsure of its generalizability...http://journals.lww.com/anesthesiology/Fulltext/2002/01000/Postoperative_Titration_of_Intravenous_Morphine_in.9.aspxhttp://journals.lww.com/anesthesiology/Fulltext/2002/01000/Anesthesiology_and_Geriatric_Medicine__Mutual.6.aspxDoes anyone have any specific policy with respect to IV opiates in the elderly, or has there been any reliable research done on this in the ED setting? 2. The use of 3 in 1 / fascia iliaca blocks is gaining popularity. The evidence seems to suggest that we should be doing these under US guidance. a) Are any departments doing these as a standard of care?b) Is it ED or anaesthetics personnel that are doing them?c) Have any departments been pushing this under US guidance?A good best-bet was done on this topic http://bestbets.org/bets/bet.php?id=1024 but the real crux of the issue seems to be related to implementation and capacity building in departments with junior docs and poor staffing. 3) Does anyone do any form of initial delerium screening on their NOF patients in the ED? If not, should we, or should this be the remit of ortho-geriatrics / anaesthetics/ICU? Lots of questions, looking forward to your responses!RegardsWill Niven