مريض معروف بتمدد الأبهر البطني جاء بألم شديد في الظهر والخاصرة، وضغطه ٨٠/٥٠، ونبضه ١٣٠، وظهرت كدمات في الخاصرة. ما الأولوية؟

A client with a known AAA presents with severe back and flank pain, BP 80/50, HR 130 and flank bruising. What is the priority?

1. Give an oral analgesic and wait for the pain to ease
2. Urgent surgery and blood, accepting a relatively low pressure
3. Give two litres of saline rapidly to raise BP to 140 before imaging
4. Arrange colonoscopy to exclude GI bleeding

Answer: B) Urgent surgery and blood, accepting a relatively low pressure. These signs indicate a ruptured aneurysm, a surgical emergency. Blood is given and theatre prepared, and relatively low pressure is often accepted (permissive hypotension) because raising it with fluids can worsen bleeding.