This report describes a patient with sub-massive pulmonary embolism (PE) who was successfully treated with half-dose thrombolytics guided by the use of point-of-care (POC) ultrasound. In this case, POC ultrasound was the only possible imaging since computed tomography was contraindicated. POC ultrasound demonstrated a deep vein thrombosis and evidence of cardiac strain. In situations or locations where definitive imaging is unobtainable, POC ultrasound can help diagnose submassive PE and direct the use of half-dose tissue plasminogen activator.