A 53-year-old gentleman with history of end-stage renal disease (ESRD) secondary to hypertension followed by a gunshot wound to the left flank region, presented to the hospital with complaints of fever, chills and severe pain in the groin area. In the emergency department he was found to have a blood pressure (BP) of 70/40 mmHg, heart rate (HR) of 130/min, respiratory rate (RR) 22/min and a temperature of 38 °C. The rest of his physical examination was significant for a toxic-appearing gentleman in mild distress. Lungs were clear to auscultation and percussion. His heart sounds were distant, but had normal characteristics and no murmurs were auscultated.