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Abstract Background A female patient known to have schizoaffective disorder self‐presented to an emergency department in a state of acute agitation and paranoia shortly after a 35‐day inpatient stay at a psychiatric facility. Case report The patient exhibited no signs or complaints of dyspnea or hypoxia, but later collapsed and became hypoxic after sleeping comfortably with sedation for 12 h in the psychiatric unit. She was intubated and a computed tomography angiogram revealed bilateral lobar pulmonary emboli and right heart strain. Conclusion Psychiatric hospitalizations, medications, diagnoses and relevant sequelae increase venous thromboembolism risk more than many realize.