VASCULAR EMERGENCIES · MEMBERSHIP SURGERY

Ruptured AAA — 72M, collapsed in ED

10 decision points ~22 min Difficulty 5/5 Membership

Setting

You are the on-call general surgery registrar at a tertiary hospital with hybrid theatre, an interventional radiologist in-house on weekdays 08:00–17:00, and vascular surgery consultant covering from home overnight. Massive transfusion protocol is available. It is 03:00.

Patient

Mr T, a 72-year-old retired driver, collapsed at home two hours ago with sudden severe back and abdominal pain. He was brought in by ambulance. He is a lifelong smoker with known hypertension and an AAA screening result of 6.2 cm eighteen months ago that he never followed up. Vitals on arrival: BP 78/40, HR 112, RR 26, GCS 13, cold peripheries, a tender pulsatile epigastric mass and mottled flanks.

Reference stack

Bailey & Love 28e Ch 57 · Sabiston 21e Ch 63 · ESVS 2019 AAA guidelines · IMPROVE trial 2014 · Hardman index

Start cascade →

You'll be asked to decide what happens next at each step. There's no timer — take your time. The correct answer + evidence-anchored rationale is revealed after each choice.