A 75 year old man presents to the emergency room via EMS with a history of a presyncopal episode accompanied by sudden onset of abdominal and back pain. On physical exam the patient has a heart rate of 120 and a blood pressure of 120/84. He has a tender abdomen with a pulsatile abdominal mass. Plain film of abdomen obtained in ER demonstrated calcific rim of an abdominal aortic aneurysm (AAA).