Given that weakness and mottling were prominent, palpation of the left upper extremity for pulses was done. The left brachial, radial, and ulnar pulses were not palpable, and the left upper extremity was colder than the right upper extremity. There were also no appreciable Doppler signals. A CTA of the left upper extremity was performed, which revealed left distal brachial artery occlusion (Figure 1). Vascular surgery was consulted. Intravenous heparin drip was resumed and the patient was sent to the operating room for emergent left upper extremity exploration and embolectomy of the left brachial artery.