50 yo male, falled down 15 stairs while under heavy alcohol | Figure 1

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50 yo male, falled down 15 stairs while under heavy alcohol intoxication. Pt called 911 20 hours after the fall for a right side chest pain and progressive SOB. On my arrival, pt was in a lot of pain. on physical exam there was crepitus on multiple ribs, diffuse right side subcutaneous emphysema, 92% sats on room air and diminished air entry on the right side. Pt also had back pain on palpation and a frontal laceration. Final diagnosis: 8 ribs fractures, pneumothorax, pneumomediastinum and 2 crushed thoracic vertebrae