This 61 year old hypertensive African American man was brought to the emergency room with severe shortness of breath, pallor, and left abdominal and epigastric pain.
On admission, his vital signs were: BP 188/110, P 138, RR 30 and T 36.8°C. His physical exam was remarkable for a firm pulsatile mass felt in the abdominal lower left quadrant, and decreased femoral pulses. A CT of abdomen and chest revealed an abdominal aortic aneurysm and retroperitoneal blood. In the emergency room, he became bradycardic, apneic and unresponsive, but responded to resuscitation and then was transferred to the operating room. The abdomen was opened and the aorta was clamped above the renal arteries. The retroperitoneum was filled with blood and the margins of the aneurysm were difficult to establish. After five units of blood and 5 liters of crystalloids were given, the patient arrested on the table and was pronounced dead after all resuscitation efforts failed.
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