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Panic attack
From WikEM
Contents
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
- Trembling
- Paresthesias
- Fear of death, fear of losing control
- Depersonalization
- May feel the "urge to flee" or "sense of impending doom"
Differential Diagnosis
Shortness of breath
Emergent
- Pulmonary
- Airway obstruction
- Anaphylaxis
- Aspiration
- Asthma
- Cor pulmonale
- Inhalation exposure
- Noncardiogenic pulmonary edema
- Pneumonia
- Pneumocystis Pneumonia (PCP)
- Pulmonary embolism
- Pulmonary hypertension
- Tension pneumothorax
- Idiopathic pulmonary fibrosis acute 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
- Neoplasm
- Obesity
- Panic attack
- Pleural effusion
- Polymyositis
- Porphyria
- Pregnancy
- Rib fracture
- Spontaneous pneumothorax
- Thyroid Disease
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.
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.
Authors
Michael Holtz, Ross Donaldson, Claire, Daniel Ostermayer, Neil Young
