Case 4

A 70 y/o man is brought to the ED by ambulance following a collapse at home. His wife reported that he had been complaining of abdominal and lower back pain for the last few days. This morning in the kitchen he complained of sudden onset very severe abdominal pain radiating through to the back with associated leg weakness and then collapsed. He is obtunded on arrival with a GCS of 6, a BP of 65/40, HR 160. He is pale and mottled. He has a past history of hypertension, hypercholesterolaemia, Type 2 D.M. and is a heavy smoker.

Question 1

What is the most likely diagnosis?

Question 2

What emergency investigations can confirm this diagnosis?

Question 3

What are your priorities in resuscitating this patient?

Question 4

What is the ultimate disposition for this patient?