This case demonstrates the importance of critical care ultrasonography for all patients presenting with cardiopulmonary failure. One reason to use ultrasonography as a routine part of the initial evaluation is to identify a life-threatening process that requires prompt therapeutic intervention, such as pericardial tamponade; acute cor pulmonale with thrombus in transit; tension pneumothorax (ruled out by bilateral lung sliding); profound hypovolemia; or, as in the present patient, severe valve failure. Although uncommon, it is important to identify such cases immediately because they are amenable to specific lifesaving interventions. Another reason to perform ultrasonography routinely for initial evaluation of hemodynamic failure is to categorize the shock state, to rule out an alternative diagnosis for shock, and to develop a logical management strategy. It also helps in identifying coexisting conditions that may complicate management and may be used to follow the progress of the disease and response to therapy with sequential examinations. In the present patient, the finding of normal left ventricular function, the absence of acute cor pulmonale pattern, and the determination that the patient was not preload sensitive were important aspects of the examination. In encouraging the use of ultrasonography, the emphasis often is on what abnormalities are found. Of equal importance are the abnormalities that are not present, and early use of ultrasonography ensures that therapy for those presumptive abnormalities is not started inappropriately. In the present patient, volume resuscitation was started in the ED because of the presumption that he had septic shock. The cardiac ultrasonography showed that this treatment was not appropriate, and the critical care team discontinued it immediately.