 1. SBIRT is an effective strategy to change behavior of patients with substance abuse problems
2. Standard screening tools exist to identify patients that would benefit from Motivational Interviewing. These include the AUDIT and DAST-10. 3. Brief Motivational Interviewing requires identifying where the patient is in the stages of change and engaging them with reflective listening to motivate further change.
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 1. ITP is a diagnosis of exclusion, laboratory findings other than isolated thrombocytopenia and the associated symptoms should suggest an alternative diagnosis.
2. TTP has an extremely high mortality and early initiation of plasma exchange therapy and hematology consult can drastically improve patient outcomes. 3. DIC can be caused by many medical conditions and treatment should be at the underlying cause 4. In general, platelet transfusion is not the appropriate treatment for ITP, TTP and DIC and is often contraindicated  1. Cervical check every pregnant patient who presents with potential labor.
2. Start with transabdominal US for pregnant patients before advancing to transvaginal US. Sometimes "dates" are incorrect! 3. Be sure to ask pregnant patients about history of reproductive assistance/REI drugs. 4. Use the airway checklist for intubation preparation. 
 • Urethral injury should be suspected and excluded in patients with pelvic fractures
• Although efforts have been made to standardize capacity assessments, they are complex and subjective. Take opportunities to introduce the benefits of advance directives early. • All patients with unexplained hematuria need to be informed of this finding and have close follow up. 
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