A 72-year-old man collapses with sudden severe back and abdominal pain. He is pale, with a pulsatile abdominal mass and blood pressure of 80/50 mmHg. What is the most appropriate management?

Answer and explanation

Correct answer: A. Immediate transfer to theatre for repair of a suspected ruptured aneurysm, with permissive hypotension

  1. Step 1: A pulsatile mass with shock and back pain is a ruptured abdominal aortic aneurysm until proven otherwise.
  2. Step 2: Delay for imaging in an unstable patient is dangerous, and aggressive fluids raise pressure and dislodge clot, so surgery with limited fluid resuscitation is the aim.
Answer
Immediate transfer to theatre for repair of a suspected ruptured aneurysm, with permissive hypotension.
Why not the others: Admission to the surgical ward for analgesia, serial examinations and elective repair in six weeks: Elective repair timing does not apply to a rupture. A formal CT angiogram in the radiology suite before any surgical referral is made, whatever his state: Stable patients may have CT first, but this man is shocked and cannot wait. A 2 litre crystalloid bolus to restore a normal blood pressure before he leaves the resuscitation room: Large crystalloid volumes dilute clotting factors and raise bleeding.

Practise more Acute abdomen and vascular surgery.

Free questions with an explanation for every one, and full timed PLAB 1 (GMC, international medical graduates) mock tests.

All Acute abdomen and vascular surgery questionsTake a mock test

More Acute abdomen and vascular surgery questions

A 72-year-old man… | PLAB 1 (GMC, international medical graduates)