Pain management in ED is a challenging topic. Teaching residents to start with NSAIDS vs Narcotics and Ibuprofen- Toradol vs Morphine- Dilaudid , always could be a place for discussion/argument. Recent article in Annals studied an interesting method to administer Dilaudid, it called 1+1, instead of giving a bolus of 2 mg Dilaudid they proposed 1mg and then assess patients pain after 15 min and if needed re-dose the patient. in 1+1 group , 50 % less opioid needed to have satisfactory analgesia.