Pulmonary emboli are rare occurrences in young patients, especially those who present precipitously to the emergency department. In a young unresponsive patient, recognition of thromboembolic etiology may be delayed due to atypical presenting physiology or competing diagnoses. In this report, the authors describe an initially confounding case of catastrophic bilateral pulmonary emboli in a young woman who presented to the emergency department having been found unconscious on the street. Despite severe and prolonged hypoxia as well as multi-organ failure, the patient achieved a near complete recovery. © 2012 The Author(s).