The priority in a suspected ruptured abdominal aortic aneurysm (AAA) with hypotension is permissive hypotension to maintain a low but adequate blood pressure, minimizing further bleeding. Aggressive fluid resuscitation can increase blood pressure and worsen hemorrhage. Immediate surgical referral is critical as definitive management requires urgent repair of the aneurysm. Delays for imaging or inappropriate medical management increase mortality. This approach stabilizes the patient just enough to survive until emergency surgery.

Reference: Tintinalli's Emergency Medicine: A Comprehensive Study Guide, Judith E. Tintinalli, 9th Edition.