The ultrasound machine has quickly become a fixture in the emergency department. For good reason, the machine often lives in the trauma or resuscitation bay, seemingly anxiously awaiting use. In recent years we have seen multiple protocols and algorithms for the use of ultrasound in differentiating trauma patients. There is no doubt that it can be a powerful tool in these patients, but one must be adept with its use and aware of potential pitfalls in order to use ultrasound effectively in these high pressure situations.