Authors: Biruthvi Vignarajah, Hannah Downing, Riad Hosein / Editor: Steve Corry-Bass / Codes: GP1, RP7, SLO3, SLO6 / Published: 19/03/2020

A 76-year-old male, with a known Abdominal Aortic Aneurysm (AAA), is seen in the Emergency Department after being transferred to your centre for an urgent vascular surgery review having initially presenting with worsening abdominal pain.

He denies any nausea or vomiting, change in bowel habits, fevers, difficulty breathing, or chest pain.

On initial assessment, he is found to be hypotensive (BP 84/54) and tachycardic (HR 124). His abdomen is generally tender and tense. Bowel sounds are present.

Chest is clear, heart sounds dual, but he appears pale, is diaphoretic, and clinically hypovolaemic. The patient has a background of ischaemic heart disease, paroxysmal atrial fibrillation (on rivaroxban), permanent pacemaker, COPD, CKD, and AAA (under surveillance).