This case involves a middle-aged female patient with chronic kidney disease who presented to the ER with complaints of abdominal pain and lower extremity weakness. A physical exam revealed diminished peripheral pulses indicating vascular compromise in the legs. A CT scan revealed an abdominal aortic aneurysm but vascular surgery determined the patient did not meet the criteria for emergent surgery. The patient’s blood was then closely monitored and her volume of red blood cells and hemoglobin levels began to steadily decline. As her blood pressure continued to drop, an MRI was ordered but was never performed. There was a concern that the patient had a bowel perforation and so she was transferred to a better-equipped facility for surgical intervention. At the second hospital, a STAT CT was ordered but was not performed for several hours. The CT revealed a ruptured common iliac artery aneurysm and suffered from massive internal bleeding. An expert in cardiovascular surgery was sought to opine on the standard of care for patients presenting to the ER with these conditions.