Pulmonary embolism (PE) is a life-threatening condition with high morbidity and mortality. The presence of systolic hypotension and/or right heart strain (RHS) is currently used to stratify patients and direct management. Echocardiography has a demonstrated role in the management of PE and has been used to guide therapies such as thrombolysis. We performed a retrospective study of all patients admitted to the Nepean Hospital Intensive Care Unit (ICU) with a diagnosis of acute pulmonary embolism between 1 January 2006 and 31 December 2011 to analyse if and how echocardiography was used in the diagnosis, classification and management of these patients. During this time, 59 patients were admitted with a diagnosis of acute PE or developed a PE in the intensive care unit, of whom 22 had a diagnosis of submassive PE, demonstrating RHS on echocardiography. Eleven of these patients received thrombolysis and survived to hospital discharge. The use of echocardiography identified greater numbers of patients with high risk pulmonary embolus, enabling risk stratification for thrombolysis with potential morbidity and mortality benefit.