Large pericardial effusion with impending cardiovascular collapse is a differential diagnosis to be considered in a patient presenting with highly unstable vitals with severe shortness of breath and tachypnea. Point of care ultrasonography helps to catch the diagnosis and intervene immediately to save a life. Pericardiocentesis is an essential skill to be learnt by doctors working in the emergency department. A 25-year female with no known comorbidities was brought to the ED with severe breathlessness. Patient was connected to a cardiac monitor. She was conscious and oriented . The vitals were recorded as heart rate 116 bpm, BP 170/100 , SpO2 97% on room air and this had started  one month back, insidiously progressed to grade IV . The attendants informed that she is not able to lie supine from one day because of shortness of breath. We enquired about fever,cough and chest pain  which were absent. Patient had bilateral...