Panic attack - Revision history

Danbot: Add to Category:Symptoms - common EM chief complaint

2026-03-22T09:41:52Z

Add to Category:Symptoms - common EM chief complaint

← Older revision		Revision as of 09:41, 22 March 2026
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	<references/>		<references/>

			[[Category:Symptoms]]
	[[Category:Psychiatry]]		[[Category:Psychiatry]]

Danbot: Add GAD7_Calculator to page

2026-03-21T16:32:22Z

Add GAD7_Calculator to page

← Older revision		Revision as of 16:32, 21 March 2026
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	==Disposition==		==Disposition==
	*Discharge		*Discharge

			== Calculators ==
			{{GAD7_Calculator}}

	==See Also==		==See Also==

Rossdonaldson1: /* Management */

2022-05-12T21:11:17Z

Management

← Older revision		Revision as of 21:11, 12 May 2022
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	*Use of a brown paper bag or face mask for rebreathing has been a traditionally described treatment<ref>Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine. June 1989. 18(6): 62-628.</ref>		*Use of a brown paper bag or face mask for rebreathing has been a traditionally described treatment<ref>Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine. June 1989. 18(6): 62-628.</ref>
	**Was thought to increase the re-ventilation of expired CO2<ref>Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine. June 1989. 18(6): 62-628.</ref>		**Was thought to increase the re-ventilation of expired CO2<ref>Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine. June 1989. 18(6): 62-628.</ref>
	**However, may result in morbidity and even death if erroneously applied to patients who were hypoxic or have other underlying disorder (e.g. myocardial ischemia) <ref>Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine. June 1989. 18(6): 62-628.</ref>		**However, may result in morbidity and even death if erroneously applied to patients who were hypoxic or have other underlying disorder (e.g. [[myocardial ischemia]]) <ref>Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine. June 1989. 18(6): 62-628.</ref>
	**Any benefit provided is the result of the reassurance of “instructional manipulation” and patient belief in the treatment, rather than the elevated ~~Fico 2~~.<ref>van den Hout MA, et al. Rebreathing to cope with hyperventilation: Experimental tests of the paper bag method. Journal of Behavioral Medicine. 1988. 11:303–310</ref>		**Any benefit provided is the result of the reassurance of “instructional manipulation” and patient belief in the treatment, rather than the elevated FiCO2.<ref>van den Hout MA, et al. Rebreathing to cope with hyperventilation: Experimental tests of the paper bag method. Journal of Behavioral Medicine. 1988. 11:303–310</ref>

	==Disposition==		==Disposition==

Rossdonaldson1: /* Management */

2022-05-12T21:10:44Z

Management

← Older revision		Revision as of 21:10, 12 May 2022
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	*Consider anxiolytic (e.g. 1-2mg [[Lorazepam]] (Ativan) IV/IM/PO or 50-100mg [[Hydroxyzine]] IM)		*Consider anxiolytic (e.g. 1-2mg [[Lorazepam]] (Ativan) IV/IM/PO or 50-100mg [[Hydroxyzine]] IM)
	*Use of a brown paper bag or face mask for rebreathing has been a traditionally described treatment<ref>Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine. June 1989. 18(6): 62-628.</ref>		*Use of a brown paper bag or face mask for rebreathing has been a traditionally described treatment<ref>Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine. June 1989. 18(6): 62-628.</ref>
	**~~Thought~~ to increase the re-ventilation of expired CO2		**Was thought to increase the re-ventilation of expired CO2<ref>Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine. June 1989. 18(6): 62-628.</ref>
	**However, may result in morbidity and even death if erroneously applied to patients who were hypoxic or have other underlying disorder (e.g. myocardial ischemia) <ref>Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine. June 1989. 18(6): 62-628.</ref>		**However, may result in morbidity and even death if erroneously applied to patients who were hypoxic or have other underlying disorder (e.g. myocardial ischemia) <ref>Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine. June 1989. 18(6): 62-628.</ref>
	**Any benefit provided is the result of the reassurance of “instructional manipulation” and patient belief in the treatment, rather than the elevated Fico 2.<ref>van den Hout MA, et al. Rebreathing to cope with hyperventilation: Experimental tests of the paper bag method. Journal of Behavioral Medicine. 1988. 11:303–310</ref>		**Any benefit provided is the result of the reassurance of “instructional manipulation” and patient belief in the treatment, rather than the elevated Fico 2.<ref>van den Hout MA, et al. Rebreathing to cope with hyperventilation: Experimental tests of the paper bag method. Journal of Behavioral Medicine. 1988. 11:303–310</ref>

Rossdonaldson1: /* Management */

2022-05-12T21:10:16Z

Management

← Older revision		Revision as of 21:10, 12 May 2022
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	*Reassurance and patient education		*Reassurance and patient education
	*Consider anxiolytic (e.g. 1-2mg [[Lorazepam]] (Ativan) IV/IM/PO or 50-100mg [[Hydroxyzine]] IM)		*Consider anxiolytic (e.g. 1-2mg [[Lorazepam]] (Ativan) IV/IM/PO or 50-100mg [[Hydroxyzine]] IM)
	*Use a brown paper bag or face mask for rebreathing has been a traditionally described treatment<ref>Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine. June 1989. 18(6): 62-628.</ref>		*Use of a brown paper bag or face mask for rebreathing has been a traditionally described treatment<ref>Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine. June 1989. 18(6): 62-628.</ref>
	**Thought to increase the re-ventilation of expired CO2		**Thought to increase the re-ventilation of expired CO2
	**However, may result in morbidity and even death if erroneously applied to patients who were hypoxic or have other underlying disorder (e.g. myocardial ischemia) <ref>Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine. June 1989. 18(6): 62-628.</ref>		**However, may result in morbidity and even death if erroneously applied to patients who were hypoxic or have other underlying disorder (e.g. myocardial ischemia) <ref>Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine. June 1989. 18(6): 62-628.</ref>

Rossdonaldson1: /* Management */

2022-05-12T21:09:50Z

Management

← Older revision		Revision as of 21:09, 12 May 2022
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	==Management==		==Management==
	*Reassurance and patient education		*Reassurance and patient education
	*~~Use a reservoir bag with supplemental oxygen~~		*Consider anxiolytic (e.g. 1-2mg [[Lorazepam]] (Ativan) IV/IM/PO or 50-100mg [[Hydroxyzine]] IM)
	*1-2mg [[Lorazepam]] (Ativan) IV/IM or 50-100mg [[Hydroxyzine]] IM		*Use a brown paper bag or face mask for rebreathing has been a traditionally described treatment<ref>Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine. June 1989. 18(6): 62-628.</ref>
			**Thought to increase the re-ventilation of expired CO2
			**However, may result in morbidity and even death if erroneously applied to patients who were hypoxic or have other underlying disorder (e.g. myocardial ischemia) <ref>Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine. June 1989. 18(6): 62-628.</ref>
			**Any benefit provided is the result of the reassurance of “instructional manipulation” and patient belief in the treatment, rather than the elevated Fico 2.<ref>van den Hout MA, et al. Rebreathing to cope with hyperventilation: Experimental tests of the paper bag method. Journal of Behavioral Medicine. 1988. 11:303–310</ref>

	==Disposition==		==Disposition==

Beren85: /* Clinical Features */

2022-05-05T17:09:16Z

Clinical Features

← Older revision		Revision as of 17:09, 5 May 2022
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	**Depersonalization		**Depersonalization
	*May feel the "urge to flee" or "sense of impending doom"		*May feel the "urge to flee" or "sense of impending doom"
			*The acute respiratory alkalosis can cause a transient imbalance of calcium, potassium and other ions, with the net effect of increasing the irritability of excitable muscles and nerves

	==Differential Diagnosis==		==Differential Diagnosis==

Beren85: /* Management */

2022-05-05T17:06:49Z

Management

← Older revision		Revision as of 17:06, 5 May 2022
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	==Management==		==Management==
	*Reassurance and patient education		*Reassurance and patient education
	*1-2mg [[Lorazepam]] (Ativan) IV/IM		*Use a reservoir bag with supplemental oxygen
			*1-2mg [[Lorazepam]] (Ativan) IV/IM or 50-100mg [[Hydroxyzine]] IM

	==Disposition==		==Disposition==

Beren85: /* Clinical Features */

2022-05-05T17:03:57Z

Clinical Features

← Older revision		Revision as of 17:03, 5 May 2022
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	**[[Nausea]]		**[[Nausea]]
	**Trembling		**Trembling
			**Flexor spasm of hands and feet (carpopedal spasm)
	**Paresthesias		**Paresthesias
	**Fear of death, fear of losing control		**Fear of death, fear of losing control

ClaireLewis at 00:27, 11 December 2016

2016-12-11T00:27:39Z

← Older revision		Revision as of 00:27, 11 December 2016
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	==Clinical Features==		==Clinical Features==
	*Discrete period of intense fear or discomfort that peaks within a few minutes '''plus'' at least four of the following:<ref name="Foldes">Foldes-Busque G, Denis I, Poitras J, Fleet RP, Archambault P, Dionne CE. A prospective cohort study to refine and validate the Panic Screening Score for identifying panic attacks associated with unexplained chest pain in the emergency department. BMJ Open. 2013;3(10):e003877. doi:10.1136/bmjopen-2013-003877.</ref>		*Discrete period of intense fear or discomfort that peaks within a few minutes '''plus'' at least four of the following:<ref name="Foldes">Foldes-Busque G, Denis I, Poitras J, Fleet RP, Archambault P, Dionne CE. A prospective cohort study to refine and validate the Panic Screening Score for identifying panic attacks associated with unexplained chest pain in the emergency department. BMJ Open. 2013;3(10):e003877. doi:10.1136/bmjopen-2013-003877.</ref>
	**[[Chest pain]]		**[[Chest pain]], [[palpitations]]
	**~~Palpitations~~		**[[Dyspnea]], feeling of suffocation
	**Dyspnea		**Diaphoresis, hot or cold flashes
	**Feeling of suffocation		**[[Nausea]]
	**Diaphoresis
	**Hot or cold flashes
	**Nausea
	**Fear of death
	**Fear of losing control
	**Trembling		**Trembling
	**Paresthesias		**Paresthesias
			**Fear of death, fear of losing control
	**Depersonalization		**Depersonalization
	*May feel the "urge to flee" or "sense of impending doom"		*May feel the "urge to flee" or "sense of impending doom"
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	==Evaluation==		==Evaluation==
			*Diagnosis of exclusion: must rule out organic causes of symptoms (see [[chest pain]], [[palpitations]], [[shortness of breath]], etc.)
	*Clinical diagnosis, based on history and physical exam.		*Clinical diagnosis, based on history and physical exam.