Critical care was consulted for management of acute hypoxic respiratory failure. On evaluation by the intensivist team, the patient was agitated, diaphoretic, and tachycardic and had diffuse rales bilaterally on lung auscultation. Other physical examination findings were unremarkable. The postintubation arterial blood gas (ABG) measurements revealed a pH of 7.30, Pco2 of 45 mm Hg, Po2 of 144 mm Hg, and lactic acid level of 6.1 mmol/L. Broad-spectrum antibiotics were administered. The ventilator settings were as follows: pressure-regulated volume control with a tidal volume of 400 mL, respiratory rate of 18/min, peak end-expiratory pressure of 15 cm H2O, and Fio2 of 100%. In the subsequent 2 h, the patient’s clinical condition rapidly deteriorated. A shock state developed, and worsening hypoxemia ensued. The intensivist team performed a bedside ultrasound to determine the cause of the shock state (Fig 2, Video 1).