**Question:** A 19 year old girl sustained blunt abdominal trauma. She was diagnosed of having splenic rupture. Her pulse is 110/min and BP is normal. She is tachypnoeic with respiratory rate of 22/min and she is anxious. Her approximate blood loss is -

A. 1000 ml
B. 2000 ml
C. 3000 ml
D. 5000 ml

**Correct Answer:** D. 5000 ml

**Core Concept:**

Splenic rupture is a potentially life-threatening injury that occurs when the spleen is damaged, leading to bleeding into the abdominal cavity. In such cases, the patient may present with various clinical signs and symptoms depending on the severity of the injury. Blunt abdominal trauma typically results in a combination of hemodynamic instability, respiratory distress, and anxiety due to the injury's impact on the patient's physiology.

**Why the Correct Answer is Right:**

The correct answer (5000 ml) is based on the patient's clinical presentation, as described in the question. When there is significant blood loss due to splenic rupture, the patient often exhibits signs of hypovolemic shock and dehydration, including:

1. Rapid heart rate (110 beats per minute)
2. Normal blood pressure (no mention of hypotension)
3. Tachypnoea (respiratory rate of 22 breaths per minute)
4. Anxiety (as she is anxious)

These clinical findings suggest a significant blood loss, even though her blood pressure is normal. The patient's tachypnoea indicates respiratory distress due to hypovolemic shock, and her anxiety is a consequence of the trauma and pain. Blood loss of 5000 ml would lead to the described symptoms and signs.

**Why Each Wrong Option is Incorrect:**

A. 1000 ml: This is too low for the patient's symptoms and signs of hypovolemic shock (low blood pressure, tachypnoea, and anxiety). A blood loss of 1000 ml would not lead to the described symptoms and signs.

B. 2000 ml: Blood loss of 2000 ml may lead to the described symptoms and signs of hypovolemic shock, but it is still less than the correct answer (5000 ml).

C. 3000 ml: Blood loss of 3000 ml may lead to the described symptoms and signs of hypovolemic shock, but it is still less than the correct answer (5000 ml).

D. 5000 ml: This is the correct answer, as it aligns with the described symptoms and signs of hypovolemic shock (low blood pressure, tachypnoea, and anxiety). A blood loss of 5000 ml would lead to the described symptoms and signs, providing a close approximation to the actual blood volume loss needed to cause the described clinical picture.

**Clinical Pearl:**

In cases of splenic rupture,