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Evidence-Based Medicine 2009;14:134-135; doi:10.1136/ebm.14.5.134
Copyright © 2009 by the BMJ Publishing Group Ltd.

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EBM notebook

45-year-old male from an RTA with isolated sternal fracture: immediate discharge or hospital admission?

Munier Hossain

North West Wales NHS Trust; Gwynedd, UK

The first 150 words of the full text of this article appear below.

A late night call: the patient and the problem

Orthopaedic on-calls are traditionally busy during summer. It was quite late, or rather, early in the morning that I eventually retired to bed. As soon as I managed to go to sleep the mobile went off. "Mr. Hossain"—it was the switchboard on the line—"the SHO [senior house officer] would like a word with you".

The night on-call SHO had limited previous orthopaedic experience. He had a patient: a 45-year-old male, road traffic accident (RTA) with an isolated sternal fracture. The patient was well and had no other injuries. He had refused analgesia and was keen to be allowed to go home. However, the SHO was worried that he might have sustained occult cardiac injuries. At his previous practice, these patients were investigated and admitted overnight for cardiac monitoring. He was not happy to discharge the patient. What should he do? I had not followed recent literature on this . . . [Full text of this article]


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