Ultrasound-based assessment of critically ill patients has a paramount role. In the approach to the medical unstable patient as to follow his clinical course. The advances in ultrasound technology including reduced equipment size and price have had a major role in the expansion of its use outside the cardiology laboratory to the point of care ultrasound. To date ICU and Emergency Phisicians are confident to use it in focus cardiac ultrasound with an important diagnostic and clinical support. The perioperative period is a source of complications that anesthesiologist can evaluate with ultrasound as hypovolemic states, tamponade, pulmonary embolism, cardiac failure and sepsis. To date, to establish the training and to develop practice guidelines for non-cardiologist-performed transthoracic echocardiography is a growing issue.