A 30-year-old-woman has been brought to hospital by ambulance

Her condition was serious. The preliminary diagnosis was "rupture of a uterine tube with internal bleeding due to ectopic pregnancy". On the way to hospital the patient lost consciousness several times. Examination in hospital showed that the patient was conscious, but confused. She was markedly pale, had a weak, rapid pulse; ausculation revealed muffled heart sounds; blood pressure 80/35 mm Hg. Examination showed the presence of varicous veins in the extremities. The patient told the physician that her condition worsened suddenly when she was removing hair on her legs with a depilator. Unexpectedly she felt short of breath, palpitations, pain in the heart. Later on in hospital, despite inhalation of oxygen, she went on complaining of shortness of breath.

Questions:

Which of the typical pathologic processes and what type of it could develop in the patient? Substantiate your answer.

Name the symptoms caused by this pathologic process. What are the mechanisms, underlying each of the symptoms?

Describe the causative factors of this pathologic process. Which of them are most likely to occur?

Why was the inhalation of oxygen ineffective to alleviate shortness of breath?

Case 4

When a physician of the emergency service arrived at the site of a vehicle accident he found that the victim of the accident developed shock associated with an open fracture of the right leg and massive loss of blood. The patient also had a closed chest injury. When the bleeding was stopped by application of a tourniquet the physician injected to the patient subcutaneously appropriate doses of morphine (to alleviate pain) and a stimulant of the cardiac function. However, the treatment had no effect. The symptoms of shock continued to progress, the pulse was observed only in the large arteries (60 beats/min), blood pressure decreased up to 60/25 mm Hg. Auscultation revealed a depressed breathing over the left chest, and no breathing sounds over the right chest. Several minutes later breathing became shallow and ineffective; the patient started to "gasp air". With the aim to stimulate breathing the physician injected subcutaneously a stimulant of the respiratory center. However, this treatment also had no effect.

Questions:

What type (or types) of emergency state developed in the patient?