The respiratory rate is around 40, and the patient is obviously very distressed and becoming tired. Feeling the chest you notice a lot of crepitus on the right side (which is very painful), and one large segment seems to be moving paradoxically (indrawing when the chest expands, and vice versa). The trachea is central, but chest expansion is poor and the patient is hardly shifting any air. Breath sounds are quiet bilaterally though the traffic noise is quite loud. What do you think is going on?