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A 79-year-old man presents to the emergency department with abdominal pain. The patient describes the pain as severe, tearing, and radiating to the back. His history is significant for hypertension, hyperlipidemia, intermittent claudication, and a 60 pack-year history of smoking. He also has a previously diagnosed stable abdominal aortic aneurysm followed by ultrasound screening. On exam, the patient's temperature is 98°F (36.7°C), pulse is 113/min, blood pressure is 84/46 mmHg, respirations are 24/min, and oxygen saturation is 99% on room air. The patient is pale and diaphoretic, and becomes confused as you examine him. Which of the following is most appropriate in the evaluation and treatment of this patient?
Abdominal CT with contrast
Abdominal CT without contrast
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A 68-year-old male with past history of hypertension, hyperlipidemia, and a 30 pack/year smoking history presents to his primary care physician for his annual physical. Because of his age and past smoking history, he is sent for screening abdominal ultrasound. He is found to have a 4 cm infrarenal abdominal aortic aneurysm. Surgical repair of his aneurysm is indicated if which of the following are present?
Abdominal, back, or groin pain
Diameter >3 cm
Growth of < 0.5 cm in one year
A 73-year-old woman with a history of hypertension, diabetes, and coronary artery disease presents to the emergency department with severe back pain. She states that the pain started approximately 30 minutes ago and she has felt lightheaded and dizzy ever since its onset. Her temperature is 98.1°F (36.7°C), blood pressure is 80/50 mm Hg, pulse is 130/min, respiratory rate is 17/min, and oxygen saturation is 98% on room air. A bedside ultrasound of the abdomen is performed as seen in Figure A. What is the best next step management for this patient's current presentation?
Discharge and serial outpatient ultrasounds
Endovascular surgical repair
Volume resuscitation and observation