Pulmonary embolism (PE) is a major source of morbidity and mortality. The presentation of acute PE varies, ranging from few or no symptoms to sudden death. Patient outcome depends upon how well the right ventricle can sustain the increased afterload caused by the embolic burden. Careful risk stratification is critical and the pulmonary embolism response team (PERT) concept offers a rapid and multidisciplinary approach. Anticoagulation is essential unless contraindicated; thrombolysis, surgical embolectomy, and catheter-directed approaches are also available. Clinical consensus statements have been published which offer a guide to PE management, but areas remain for which the evidence is inadequate. While the management of low-risk and high-risk patients is more straight-forward, optimal management of intermediate-risk patients remains controversial. In this document, we offer a case-based approach to PE management, beginning with diagnosis and risk stratification, followed by therapeutic alternatives, and finishing with follow-up care.