The patient exhibited rapidly worsening hemodynamic instability with clinical and point-of-care evidence of an immediately life‑threatening surgical process unresponsive to maximal resuscitation, making operative control the only viable option to prevent imminent decompensation. Imaging and labs indicated ongoing internal compromise (e.g., hemorrhage/perforation with peritonitis), and the risk of delay outweighed the risks of proceeding under implied emergency consent. Protocol verification confirmed OR readiness, anesthesia and blood product availability, and security authorization for emergency override; nonoperative or interventional alternatives were deemed insufficient given the trajectory. The team was briefed, massive transfusion and airway contingencies were activated, and postoperative critical care planning was established.