Do not waste time in ED trying to "stabilize" patient
Immediate surgery consultation/ go to OR
Crossmatch 6 units of pRBC
Pain control (avoid hypotension)
Antihypertensives (use with caution, goal SBP 110-120 mmHg or MAP 70-80)
Labetalol: 20mg IV, then 40-80mg IV q10 min (max 300mg)
Esmolol: Bolus 500 mcg/kg, then 50-200 mcg/kg/min
Nitroprusside: 0.3 - 0.5 mcg/kg/min, titrate to max 10 mcg/kg/min
Controversial
Too little (ischemia), too much (increased bleeding)
Consider allowing for permissive hypotension (SBP 70-90) in conscious patient
Pressors
Norepinephrine 0.05mcg/kg/min IV; titrate by 0.02mcg/kg/min q5min
Phenylephrine 100-180mcg/min; titrate by 25mcg/min q10min
Dopamine 5mcg/kg/min; titrate by 5mcg/kg/min q10min
Labetalol: 20mg IV, then 40-80mg IV q10 min (max 300mg)
Esmolol: Bolus 500 mcg/kg, then 50-200 mcg/kg/min
Nitroprusside: 0.3 - 0.5 mcg/kg/min, titrate to max 10 mcg/kg/min
Too little (ischemia), too much (increased bleeding)
Consider allowing for permissive hypotension (SBP 70-90) in conscious patient
Pressors
Norepinephrine 0.05mcg/kg/min IV; titrate by 0.02mcg/kg/min q5min
Phenylephrine 100-180mcg/min; titrate by 25mcg/min q10min
Dopamine 5mcg/kg/min; titrate by 5mcg/kg/min q10min
Consider allowing for permissive hypotension (SBP 70-90) in conscious patient
Norepinephrine 0.05mcg/kg/min IV; titrate by 0.02mcg/kg/min q5min
Phenylephrine 100-180mcg/min; titrate by 25mcg/min q10min
Dopamine 5mcg/kg/min; titrate by 5mcg/kg/min q10min<unk>  > 5 cm: Prompt (within days) vascular surgery outpatient follow-up appt
Endovascular (75%) vs open repair<unk>  3-5 cm: Can likely follow up with PCP/surgeon on non-urgent basis
Screening frequency:
3-4 cm diameter: 12 months
4-5 cm diameter: 6 months
5-6 cm diameter: 1 month
Elective Surgery indicated if:<unk>  > 5.5 cm in men <unk>  > 5 cm in women 
increase in size > 1 cm/year
increase in size > 5 mm/6 months
Endovascular (75%) vs open repair
3-4 cm diameter: 12 months
4-5 cm diameter: 6 months
5-6 cm diameter: 1 month<unk>  > 5.5 cm in men <unk>  > 5 cm in women 
increase in size > 1 cm/year
increase in size > 5 mm/6 months
Abdominal aortic aneurysm
Splenic artery aneurysm
Aortocaval fistula
Superior mesenteric artery syndrome
Acute gastroenteritis
Mesenteric vein thrombosis
Aortoenteric fisulta
Splenic infarction