In suspected arterial occlusion of a peripheral limb, what is the initial management step?

• A. IV heparin
• B. Embolectomy
• C. Thrombolysis
• D. Vasopressors

Answer: (A)

Initiate intravenous heparin anticoagulation right away. In suspected arterial occlusion of a limb, this immediate anticoagulation prevents further thrombus propagation and embolization, buying time to assess limb viability and arrange definitive revascularization. It stabilizes the situation without delaying diagnostic imaging or urgent procedures that may be needed to restore blood flow.

Other options serve specific roles but are not the starting move. Revascularization procedures like embolectomy are performed once the patient is stabilized and a plan for restoring perfusion is made. Thrombolysis may be used in certain scenarios but carries bleeding risks and isn’t the first step in suspected acute limb ischemia. Vasopressors do not address the underlying blockage and can worsen limb perfusion due to vasoconstriction. If there are contraindications to heparin (e.g., active major bleeding), alternatives or careful risk-benefit decisions are needed.