We initiated emergency surgery because the patient showed signs of imminent decompensation—refractory hypotension, rising lactate, and imaging/bedside assessment indicating ongoing hemorrhage—despite aggressive resuscitation. Temporizing measures (airway stabilization, blood products via massive transfusion protocol, and vasopressors) failed to achieve protocol-defined hemodynamic targets within the critical window. Under emergency consent doctrine and per trauma/acute care algorithms, immediate operative control offered the only timely path to hemorrhage control and prevention of irreversible shock and multi-organ failure. OR readiness, team availability, sterile field, and security/access controls were verified prior to incision to mitigate procedural risk.