<p>Acute pulmonary embolism is a common and potentially fatal condition in intensive care and emergency medicine. The mortality rate within the first few hours of its occurrence is particularly high; thus, even in the event of clinical suspicion, immediate initiation of diagnostics and treatment is crucial. The current European and national guidelines on acute pulmonary embolism provide valuable and practical support on this topic and form the basis of this review. A particular focus lies in the presentation of a risk-adapted and algorithm-based diagnostic and therapeutic approach. In particular, there are new recommendations regarding risk stratification and differentiated therapy, which are discussed in this article.</p>