Resuscitative TEE in the diagnosis of massive PE in the ED. We have multiple tools in the ed that allow us to assess patients rapidly. But of course, you must use the right tool for the patient. transthoracic echo (TTE) can be useful to assess a patient in shock and is our go-to tool when we approach a patient with hemodynamic decompensation or shock. But what happens when tte fails you? What happens if tte views are not obtainable or suboptimally to make any informed clinical decisions off of? How do you ensure you meet the standard of care and obtain the information you need to make decisions?

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