The importance of transesophageal echocardiography (TEE) in the general intensive care setting has gradually increased, even in non-cardiac critically ill patients. Hemodynamic instability, suspected endocarditis, aortic dissection, and source of embolus are common indications of TEE in intensive care unit (ICU), but the case distribution in different studies is due to differences in patient population and in the trends for performing TEE. The threshold for the use of echocardiography in intensive care has decreased. Transmitral flow and propagation velocity, pulmonary vein flow velocity, and tissue Doppler velocity may all be valuable in assessing diastolic dysfunction. TEE is also important in the evaluation of the position and the direction of the ventricular assist device (VAD) inflow cannula. The critical care and emergency room setting provides an opportunity to utilize basic echo screening protocols, as well as formal transthoracic echocardiography (TTE) and TEE.