Videos 5 through 9 show the patient’s echocardiographic examination. Video 5 is the parasternal long-axis view and shows a circumferential anechoic space surrounding the heart, which represents the PEF. When the PEF is predominately posterior, it may be confused for a PLEF. PEFs will climb anterior to the descending thoracic aorta, whereas a PLEF will dive deep to the descending aorta. Although not well visualized in this video, the RV outflow track may reveal early diastolic collapse in tamponade. The RV outflow tract is the more compressible area of the right ventricle and tends to collapse earlier than the body of the right ventricle. Video 6 is the parasternal short-axis view demonstrating normal left ventricular function with a circumferential PEF. The interventricular septum demonstrates mild flattening throughout the cardiac cycle, suggesting possible RV volume and/or pressure overload. In the context of the rapidly progressive PEF, we believed that the mild flattening was an unlikely cause for the patient’s shock state. Video 7 is the apical four-chamber view. Due to the patient’s body habitus and respiratory status, a good on-axis view was impossible. However, lateral to the left ventricle, the PEF was more echogenic, with a plankton-like appearance likely representing an inflammatory or infectious process. It was not possible from this view to determine if there was a collapse of the right-sided chambers throughout the cardiac cycle, indicative of tamponade physiology. Video 8 displays the subcostal view, which provides excellent visualization of the changes in the right atrium and ventricle when pericardial pressures exceed intracardiac pressures. Our patient’s subcostal view reveals the circumferential nature of the effusion and plankton sign, as seen in the apical four-chamber view. The right ventricle appears to be collapsed throughout the cardiac cycle. There is no evidence of RA systolic collapse. A real-time ECG tracing is helpful in determining which part of the cardiac cycle chambers are being compressed. Due to the urgency in this case, this procedure was not performed. Video 9 is an M-mode image of the IVC in the longitudinal axis just before it empties into the right atrium. It is 2.51 cm in diameter and does not vary in size with respiration. A distended IVC without variation is a universal finding in cardiac tamponade. Although it is extremely sensitive for tamponade, it is not very specific because patients may not be volume responsive, they may have preexisting pulmonary hypertension, or they may be receiving mechanical ventilation; all of these factors increase the diameter of the IVC and cause a reduction in the magnitude of respiratory variation.