Ultrasonography is an essential imaging modality in critical care to diagnose and guide the treatment of shock, respiratory failure, and multiorgan failure. Competence in critical care ultrasonography (CCUS) has been defined in the American College of Chest Physicians/La Société de Réanimation de Langue Française Statement on Competence in Critical Care Ultrasonography, which is the foundation document of the Statement on Training in Critical Ultrasonography., The latter statement is the product of a cooperative effort by 22 international societies of critical care. By definition, CCUS requires that all image acquisition, image interpretation, and clinical application of ultrasonography is personally performed by the critical care clinician at the point of care. This allows for immediate integration of ultrasonography results with the history, physical examination, and laboratory results, yielding a powerful clinical synergy. This is different than traditional ultrasonography as performed by the consultant radiology or cardiology services, where there is a predictable delay in performance, interpretation, and transfer of information to the ICU team. In addition, the consultant is disassociated from the case (ie, they are not fully aware of the reality of the front-line ICU situation). The role of the point of care ultrasonographer is not to replace expert level consultation by radiology or cardiology services, but to recognize the need for these services when the critical care team determines that consultative service is required.