Hot Seat #252: “O.I.” was in an accident
Posted on: January 5, 2026, by : Brittany Fitzpatrick
Case by Sarah Benett, CNH PEM Fellow
19 year old female with a history of Osteogenesis Imperfecta Type VIII and restrictive lung disease presenting with rib pain after an MVC that occurred earlier that day. Mom reports they were traveling 55 mph on the highway when they were hit on the right side by another vehicle. Patient was strapped in her wheelchair and wearing a seatbelt on the left side of the back seat. She denies any LOC and did not hit her head. At the time of the accident, she was complaining of decreased sensation to her legs that has since resolved. However, she continues to complain of pain in her rib cage area rated 8/10, especially when she is taking deep breaths. Patient arrived via private vehicle and EMS was not at the scene. She is followed by orthopedics and pulmonology at CNMC.
Vitals: T 37, HR 72, RR 20, SpO2 99% on RA, No BP documented as parents refused d/t concern for fracture.
Physical Exam
General: Alert, appropriate for age.
Skin: Warm, moist, no rash
Head: Normocephalic, atraumatic
Eyes: Extraocular eye movements intact.
Cardiovascular: Regular rate and rhythm, no murmur, normal peripheral perfusion.
Respiratory: Lungs clear to auscultation, respirations are non-labored.
Chest wall: Tenderness to palpation of the left rib cage area. No ecchymosis or crepitus. No swelling.
GI: Abdomen soft, tender, nondistended
MSK: Moves all extremities. UE and LE with contractions, normal strength and sensation.
Neurological: Alert, Cooperative.
Chest XR and Rib XR come back and show stable multilevel rib deformities that represent multiple healing fractures, limiting evaluation or acute fracture. Given medical history, labs were difficult to obtain. Pain re-assessment demonstrated no pain pain in LUQ and chest wall.
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