After diagnostic confirmation additional large bore vascular access was started, STAT surgical consult requested, and an esmolol bolus/infusion administered, titrating frequently to target a HR<60 and an SBP 100-120. Analgesia achieved with fentanyl pushes. A right radial arterial line was placed. Nicardipine drip started after failing to reach target with esmolol. Hemodynamic targets achieved shortly after nitroprusside infusion started. Transferred to surgical ICU for medical management.

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