Emergency care takes on a different face in tactical and austere environments where hospital or emergency department facilities are nonexistent and diagnostic capability may be limited to the largely unreliable physical examination (Solomon SD, Saldana F, N Engl J Med 370:1083–5, 2014). However, timely interventions in critical situations are necessary and in some cases may be more effective and lifesaving over delayed interventions minutes to hours or even days after recovery is no longer possible. Such critical maneuvers may need to be performed with minimal equipment and assessment and occur in suboptimal conditions. Few diagnostic instruments or methods are possible in tactical and austere settings, where a backpack must contain the entirety of the portable emergency department. The only practical diagnostic tool is the portable ultrasound machine. Yet the range of possible interventions can be surprisingly broad.