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Triage and first 5 minutes
Instability screen
Hypotension
Systolic blood pressure under 90 mmHg
Shock index over 1
High risk pain pattern
Sudden severe abdominal pain
Sudden severe back or flank pain
Perfusion threat
Altered mental status
Cool mottled skin
Rupture concern
Syncope or near syncope
Rapid hemoglobin fall
Early parallel actions
Team activation
Vascular surgery or interventional radiology activation for rupture pathway
Anesthesia and operating room notification for high suspicion
Monitoring
Cardiac monitor
Continuous pulse oximetry
Vascular access
Two large bore peripheral IV
Rapid infuser availability
Bedside imaging
Point of care ultrasound aorta for immediate confirmation
If unstable and positive POCUS then rupture pathway without delay
Hemodynamic strategy
Permissive hypotension for suspected rupture
Conscious patient target
Systolic blood pressure 80 to 90 mmHg
Palpable radial pulse acceptable surrogate
Avoid over resuscitation
Minimize crystalloid
Early blood products for hemorrhagic shock
If profound shock
Norepinephrine infusion while blood products running
Escalate to massive transfusion protocol if ongoing instability
Airway and ventilation considerations
Intubation risk
Hemodynamic collapse with induction
Prepare push dose vasopressor
If intubation required
Minimize positive pressure ventilation until blood products started
Lowest effective PEEP
Time critical decision points
Diagnostic pathway choice
Hemodynamically unstable
POCUS positive AAA then immediate vascular surgery pathway
CT deferred if delays definitive hemorrhage control
Hemodynamically stable
CT angiography abdomen and pelvis for operative planning
Transfer decision if no endovascular capability
Key pitfalls
Normal blood pressure does not exclude rupture
Transient tamponade by retroperitoneum
Early presentation before decompensation
Absent palpable mass does not exclude AAA
Obesity
Small aneurysm rupture
Anchoring on renal colic
First episode flank pain in older smoker
Pain with syncope
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.