Bedside ultrasound can be super helpful in assessing and managing the sick patient. This learning opportunity that I'll be sharing at dasSMACC was provided to me by a lovely 65yr man who presented to ED late one Tuesday evening last year. From a brief history, examination and bedside echo we were able to diagnose him with acute pulmonary embolism with right heart strain and residual thrombus in his right atrium. This is an uncommon scenario but is associated with high mortality if left untreated or treated with anticoagulation alone, and patients have much better odds of surviving with thrombolysis or embolectomy.