So, this problem isn't because the patient is too sick, it's because they're too healthy. Arterial spasm. It's amazing to go from a bounding radial pulse to nothing in one or two passes. A short axis US view shows all media and maybe a .5 mm lumen. You can actually see the muscle fibers like a donut around a tiny black dot in some cases.

Any young healthy patient, you might get 2 trys if spasm occurs. You can switch arms and/or march up the arm, but just going to sleep and placing post induction may be the call you make before you go to all that trouble in the first place.

Even post induction, 3-4 cc's of local helps avoid spasm in these folks IME. I try to go pretty proximal, where the vessel is larger and emerges from beneath the distal brachioradialis. US or Doppler helpful.