Urgent surgery for a ruptured abdominal aortic aneurysm

An elderly man presents to ED with worsening pain. What’s the next move?

Bill, a normally well 74-year-old, presents to the emergency department of a regional Queensland hospital via ambulance.

Axial ct abdominal aortic aneurysm
Figure 1. Axial CT demonstrating ruptured 7cm abdominal aortic aneurysm.

He complains of central to right-sided abdominal pain that has been brewing over the previous 48 hours. He first noticed the pain in the hypogastric region, with