Inclusion Criteria:  Adults aged 18 years or older presenting to the ED or admitted to the hospital within 12 hours of enrollment Acute respiratory failure defined as new onset shortness of breath initiated within the last 7 days, and new or increasing need for oxygen therapy The patient or patient's legal health care proxy consents to participation  Exclusion Criteria:  Unwillingness to consent  Patients with trauma as the cause of ARF Patients with pneumothorax as the cause of ARF Inability to perform pulmonary POCUS or lung auscultation (e.g. dressing on the chest) Unwilling or unable to complete the minimum of 12 lung sound stethoscope recordings.