The echocardiographic approach to undifferentiated shock starts with the recognition of image patterns of hypovolemia, LV failure, RV failure, tamponade, valvular pathology, and decreased vasomotor tone. The objectives are to rapidly identify the shock mechanism, narrow down the etiology of shock, choose treatments, monitor the effectiveness of therapies, and avoid potentially harmful interventions. Advanced echocardiography techniques allow further clarifications, corrections, and adjustments of diagnosis and therapies. There are many described protocolized ultrasound approaches. While the evidence for echocardiography in shock is evolving, the ICU community has embraced the widespread use of point-of-care ultrasound in shock.