The patient was experiencing confusing symptoms that masked the major problem. Symptoms worsened, Electrocardiogram and chest x-ray were unremarkable. Our DAISY recipient picked up on subtle changes and took the opportunity to teach her orientee how to do a thorough cardiac assessment. She picked up on muffled heart tones, notified the Pediatrician and an echocardiogram was ordered showing large pericardial effusion with beginning signs of pericardial tamponade. The patient was transferred by Children’s Hospital Critical Care Air Team. This is not the first time this RN has caught a major cardiac concern in a child. We want to recognize and thank her for her outstanding work as a nurse, as a preceptor, and as an advocate for her patients.