Mid 80's male, ruptured AAA crashing to the OR for attempted EVAAAR. SBP 50-60, awake, too unstable for induction of GA, so mild to no sedation for groin cut downs. Aggressive volume replacement with PC and FFP with pressor support ongoing. No useful hx except COPD.

Lots of things going on, not the least of which is AF with an RVR of 150-160.

Ideas?