A 66-year-old woman had a brief syncopal episode after standing up from the toilet. She awoke in seconds and noted no chest pain or shortness of breath. On presentation to the ED, she had a BP of 90/60 mm Hg, a regular heart rate of 115 beats/min, temperature of 37.2°C, and a respiratory rate of 26 breaths/min. Her oxygen saturation on 4 L nasal cannula was 91%. The physical examination was otherwise unremarkable. Her chest radiograph was clear, and the ECG showed sinus tachycardia without other abnormality. Laboratory values were as follows: WBC count, 12.7 K/μL; lactate, 3.4 mmol/L; and creatinine, 2.2 mg/dL; urinalysis results were 25 WBC per high-powered field. She was given antibiotics for presumed septic shock with a urinary tract infection, and over the next few hours, per sepsis bundle protocol, she was given a total of 3 L of normal saline. The patient remained hypotensive. Norepinephrine was started at 0.5 μg/kg/min while fluid resuscitation with normal saline was continued. The patient was admitted to the medical ICU with a diagnosis of septic shock. The intensivist performed an immediate bedside ultrasound examination to diagnose and guide management of her hypotension and hypoxemia (Videos 1-3).