The patient showed signs of imminent decompensation—persistent hypotension refractory to fluids, declining mental status, and findings consistent with an acute, surgically correctable process—indicating a time-critical emergency. Non-operative measures (airway optimization, vasoactive support, and activation of the massive transfusion protocol) failed to achieve hemodynamic stability within safe thresholds. Proceeding directly to the OR under damage-control principles aligned with institutional protocols and offered the highest probability of survival, while further delay risked irreversible shock and multiorgan failure. Preoperative safety checks were completed under emergency consent exception: identity verification, allergy review, blood product readiness, antibiotic prophylaxis, and team mobilization.