CPR while aortic ballon is inserted via the femioral artery to aorta at the supraceliac or thoracic level.

Normal Saline, Followed by Type specific blood or universal donor blood (O, Rh negative1).

 

Minimize further hemorrhage through permissive hypotension.

Large-bore venous access should be obtained. Fluid resuscitation should be gauged to produce systolic blood pressures in the 80 to 100 mm Hg range with the goal of maintaining consciousness and preventing myocardial and renal ischemia but without normotension or hypertension that may propagate further hemorrhage.

Alternatively, if a patient is stable at the time of presentation or has achieved stability after resuscitation, a CT scan should be performed.

The drugs associated with intubation result in the interruption of sympathetic tone, which can hasten cardiopulmonary collapse. Consequently, intubation should be avoided in patients who can protect their airway until aortic control is imminent.

 

A computed tomography angiogram (CTA) is extremely useful not only for diagnosis but also for operative planning. Periaortic stranding on a computed tomography (CT) scan suggests rupture or impending rupture, whereas a retroperitoneal hematoma or contrast extravasation confirms that rupture has occurred.

If open surgery is being contemplated, a CT scan will identify the location of the proximal neck and extent of the aneurysm including iliac involvement, as well as the presence or absence of occlusive disease in the mesenteric, renal, or iliac circulation. This information will help with determining the location of the incision and the arteries that require treatment.

A CT scan also will determine if an endovascular approach can be used and, if so, the dimensions of the graft to be used. One of the most dreaded outcomes for a patient with a ruptured aneurysm is to expire in the CT scanner. Thus a patient who is persistently hypotensive despite active resuscitation should be taken directly to the operating room without further imaging. Alternatively, if a patient is stable at the time of presentation or has achieved stability after resuscitation, a CT scan should be performed.

 

Permissive hypotension

CTscan to determine potential for endovascular repair

Open or endovascular repair