Young Man With Shotgun Wound and Absent Ulnar Pulse

Abstract

A 30-year-old otherwise healthy man was brought to the emergency department immediately after having sustained a shotgun wound to his left upper arm (Figure 1). On arrival, his vital signs were within normal limits. Vascular examination of the affected arm revealed a palpable radial pulse but absent ulnar pulse. The hand appeared well perfused with normal capillary refill. A radiograph confirmed a number of radiopaque foreign bodies but showed no evidence of fracture (Figure 2). Point-of-care ultrasound of the ulnar artery revealed a hyperechoic structure within the vessel at the level of the wrist (Figure 3, Supplementary Video 1).