Echocardiography in the emergency room—in well-trained hands—is a valuable tool to facilitate diagnosis and initiate treatment at the patient’s bedside. Echocardiography is actually part of broad-spectrum of ultrasound-based examinations which are performed in the emergency setting—from targeted ultrasound examinations of the thorax and abdomen in a trauma patient performed by a surgeon to a comprehensive transthoracic or transesophageal examinations for aortic dissection performed by a cardiologist. This chapter covers the cardiac ultrasound in the emergency room, common clinical scenarios where echo is required, and medicolegal issues. Chest pain, trauma, hypotension, and cardiac arrest make up the most common indications for echocardiography in the emergency room.