A Great Big Hole

A previously familiar to me gentleman comes into the ER via BLS whose report includes "we just found him like this": the gentleman is curled up on his left side, with an obvious deformed knee injury, after having fallen at a nearby construction site.  V/S upon triage as follows: 93/67, 61, 18, 87% on room air... Hmmm... My oh my, humpty dumpty, where did you fall?  A quick exam reveals severely diminished lung sounds on the right side & tenderness to the lower anterior ribs on the same side.  "Umm, Charge! We gotta come back to trauma & I need a chest xray & tube like 10 minutes ago."  ER Doc comes in & examines the guy: "Sir what happened today?"  "I fell."  "Where did you fall?"  "Into a great big hole."