Most first year emergency medicine residents have at least basic facility with point of care ultrasound (POCUS). Many have skills far beyond what would have been considered adequate for a graduating EM resident 20 years ago. We ultrasound everything from optic nerves to metatarsal joints, but does it actually improve patient care? Let's start with the good news: what we know POCUS does well. Ultrasound often cuts out the middleman. Instead of waiting for a lab test or a read by radiology, we get answers in seconds at the bedside. In patients with concern for pregnancy complications, POCUS shortened the time to diagnosis of intrauterine pregnancy by 72 minutes when compared with radiology-performed ultrasound. A diaphoretic patient with chest pain can be a lot of things but a quick ultrasound that identifies a dilated aortic root can help focus care quickly, limiting time chasing other diagnoses. Ultrasound improves procedural success. POCUS efficacy for placement of central lines is well known, but it also aids peripheral intravenous (IV) placement, improving overall success, first attempt success, and decreased overall time. A 2025 meta-analysis of randomized controlled trials in pediatric emergency departments (EDs) demonstrated that POCUS improved both first attempt and overall procedural success, including IV access and lumbar puncture. Unfortunately, there has been less demonstration of morbidity or mortality benefit. Notably, the SHOC-ED trial (covered in Speed of Sound in January 2019) found that adding POCUS to the evaluation of undifferentiated shock did not add much in the terms of survival, length of stay, or several other metrics. Designing studies that meet stringent criteria to establish a mortality benefit can be difficult. A critical review from 2025 found most POCUS studies focus on accuracy and less on outcome, preventing a full assessment of its impact. It also highlighted other issues impeding the