Focused transesophageal echocardiography (TEE) is an extension of point-of-care ultrasound (POCUS) and can be used to evaluate intubated, critically ill patients in acute and critical care settings. Due to its retrocardiac position within the esophagus, TEE produces high-quality images without interference from excessive subcutaneous tissue, emphysema, external monitoring devices, and chest wall injury or surgical dressings, which can often limit the acquisition of transthoracic ultrasound images. Indications for focused TEE include the evaluation of patients with cardiac arrest, shock, respiratory failure, and severe trauma, those requiring hemodynamic monitoring, and those undergoing procedural guidance. Some of the unique qualities of TEE include the ability to help optimize the delivery of chest compressions during cardiopulmonary resuscitation, to perform serial or continuous hemodynamic monitoring, and to guide several emergency endovascular procedures, such as transvenous pacemaker placement and extracorporeal membrane oxygenation. Implementing TEE in the emergency department and intensive care unit settings has been demonstrated to be feasible, safe, and clinically impactful in managing critically ill patients.