The pt is a 49 yo F with a hx of uncontrolled hypertension and heavy smoking, presnting for a week of nausea, vomiting, diarrhea, and now abdominal pain. Pt BIB EMS, found by the to be hypotensive, on arrival to ED, pt is ashen, exrtremely pale, in distress, saying "I cant breath", hyptensive to 80s systolic, tachycardic to 130s. Her abdomen seems distended and is pulsatile on palpation. Ultrasound machine is brough into the room, shows a 9cm structure at and below the umbilicus (AAA? but too low?). Pts vitals improve enough after 2L IVF on pressure bags for her to be taken to CT, she is in the scanner 30min after arrival in ED, vascular surgery contacted before she goes to CT and actually meets her there. Findings are below.

Pt had a ruptured ILIAC artery aneurysm. Her initial pH was 7.07 and lactate 19.5. Hgb 6.2. Upon return from CT, blood was waiting for her, her vitals improved to SBP in 120s and HR  around 100. She was less pale. She was taken to the OR just over an hour after arrival in the ED. Currently in SVTU, doing well as far as I can tell.