Panic attack: Difference between revisions
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==Background== | ==Background== | ||
*Can occur de novo or in setting of psychiatric disorder (most commonly panic disorder)<ref name="Foldes" /> | |||
==Clinical Features== | ==Clinical Features== | ||
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**Paresthesias | **Paresthesias | ||
**Depersonalization | **Depersonalization | ||
*May feel the "urge to flee" or "sense of impending doom" | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 05:31, 18 August 2015
Background
- Can occur de novo or in setting of psychiatric disorder (most commonly panic disorder)[1]
Clinical Features
- Discrete period of intense fear or discomfort that peaks within a few minutes 'plus at least four of the following:[1]
- Chest pain
- Palpitations
- Dyspnea
- Feeling of suffocation
- Diaphoresis
- Hot or cold flashes
- Nausea
- Fear of death
- Fear of losing control
- Trembling
- Paresthesias
- Depersonalization
- May feel the "urge to flee" or "sense of impending doom"
Differential Diagnosis
Acute dyspnea
Emergent
- Pulmonary
- Airway obstruction
- Anaphylaxis
- Angioedema
- Aspiration
- Asthma
- Cor pulmonale
- Inhalation exposure
- Noncardiogenic pulmonary edema
- Pneumonia
- Pneumocystis Pneumonia (PCP)
- Pulmonary embolism
- Pulmonary hypertension
- Tension pneumothorax
- Idiopathic pulmonary fibrosis acute exacerbation
- Cystic fibrosis exacerbation
- Cardiac
- Other Associated with Normal/↑ Respiratory Effort
- Other Associated with ↓ Respiratory Effort
Non-Emergent
- ALS
- Ascites
- Uncorrected ASD
- Congenital heart disease
- COPD exacerbation
- Fever
- Hyperventilation
- Interstitial lung disease
- Neoplasm
- Obesity
- Panic attack
- Pleural effusion
- Polymyositis
- Porphyria
- Pregnancy
- Rib fracture
- Spontaneous pneumothorax
- Thyroid Disease
- URI
Diagnosis
- Clinical diagnosis, based on history and physical exam.
Management
- Reassurance and patient education
- 1-2mg Lorazepam (Ativan) IV/IM
Disposition
- Discharge
See Also
References
- ↑ 1.0 1.1 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.