Symptoms of AAA: pulsatile mass; abdominal pain radiating to back, flank, groin; peripheral emboli; flank and/or groin pain; melena thought to be due to aortoenteric fistula; syncope; flank mass or discoloration; lower-extremity paralysis

End

NS fluid boluses and un-cross-matched PRBCs; caution for too aggressive fluid resuscitation that may prevent local clot formation; be wary of potential of dilutional coagulopathy; aim for SBP 90-100 mm Hg; keep patient warm and consider level one infuser

Consider alternative diagnosis: musculoskeletal back pain, diverticulitis, cholecystitis, appendicitis, renal colic, pancreatitis, intestinal ischemia, bowel obstruction, myocardial infarction; epidural abscess or vertebral osteomyelitis, aortic dissection, cauda equina

Consider spiral CT

Surgery consultation

Consider spiral CT

Surgery consultation for operative repair

Vital signs, intravenous access via 2 large-bore catheters, oxygen, complete blood count, serum chemistry panel, liver function panel, type and cross-match for 6 units of blood, urinalysis, prothrombin/partial thromboplastin time, electrocardiogram, portable chest radiograph

Unstable: low BP, tachycardia, ill-appearing

Stable, but concern for AAA

Bedside US

Aorta well visualized and no sign of aneurysm

Stabilized and no clear aneurysm or doubt as to diagnosis

AAA

BP, Blood pressure; CT, computed tomography; MRI, magnetic resonance imaging; NS, normal saline; PRBCs, packed red blood cells; SBP, systolic blood pressure; US, ultrasonography.

Consider alternative diagnosis: musculoskeletal back pain, diverticulitis, cholecystitis, appendicitis, renal colic, pancreatitis, intestinal ischemia, bowel obstruction, myocardial infarction; epidural abscess or vertebral osteomyelitis, aortic dissection, cauda equina

Spiral CT (fastest and easiest); MRI; angiography