Panic Attack? That isn't supposed to happen.

MMiz

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This wasn't my call, but something I heard a few days ago from a friend. It makes sense to me, but I'm still a bit confused.

Woman uses unmanned FD station phone to call 911. Her boyfriend didn't think they'd make it to the hospital.

EMS ATF 19 y/o distraught female.

S: Pt complaining of abdominal pain and tingling in both arms and hands. Patient's fingers are bent in awkward claw-like positions.
A: NKDA
M: Denies
P: No pertinent medical hx
L: Ate mean a couple of hours prior
E: Patient had rough day at work, doesn't want to talk about it, came home, and now experiencing symptoms

O: 30 minutes prior to arrival
P: Nothing makes it better or worse, symptoms are consistent
Q: Tingling in arms and hands
R: No radiation
S: 4-5
T: 30 minutes prior, no change in pt's condition

Vitals: I don't have vitals, but here is a guess:
R: 22
P: 110
....

Pt was placed on O2 @ 2LPM via NC. After talking with pt for only minutes, pt's condition completely normalized. Pt was transported without incident or change in condition.

Hospital dx was a panic attack. What was with the fingers? Friend explained it due to lack of O2 and blood perfusion to extremities, but I've never seen or heard of it. My first thoughts were ectopic pregnancy or neuro.
 

Guardian

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Sounds like classic hyperventilation. Swallowing too much air causes bloating and stomach ache. A drop in co2 causes a wide variety of nervous system symptoms and a drop in calcium causes muscle cramps and spasms, especially in the extremities. I usually have to deal with one of these basket cases every week or so.
 

akflightmedic

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Guardian pretty much summed it up.

That is classic presentation of hyperventialtion.

When you get these patients, ask if their lips or face is numb. Ask if their toes are cramped. The curled up hands are a huge ding ding ding!!!!

These patients need to be talked down usually. Remove all extra personel, any stimuli, lights/sirens, shut them off. Get in front of the patient and talk quietly and slowly and encourage them to focus on you while you get them to regain control of their breathing. Talk slow and steady, everything is ok, in your nose out your mouth..nice and slow. You do this over and over until they start to breathe normal and then their hands uuncramp and their body quits tingling. Then you get a refusal and go back to bed...LOL.

If done properly, you can have them back to normal and able to leave within 20 mins or so. For me, that is worth it instead of transporting them, waiting at the ER forever and then doing a report while tying up the unit that could be needed elsewhere.

It takes a patient provider to do all of this. A lot of people I work with just rather throw them in the truck and dump them as soon as possible.
 

MMiz

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Thanks for the additional information. After reading your responses, and confirmed by a quick google, it seems as though I truly missed the classic case of hyperventilation. I missed it, and I mean I really missed it.

Thanks!
 

Guardian

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It takes a patient provider to do all of this. A lot of people I work with just rather throw them in the truck and dump them as soon as possible.

Lack of patience in an issue I’ve been seeing a lot lately. I might even start a thread on it soon.

MMiz, I guess you're just a mere mortal like the rest of us.
 

emtkelley

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My hands do the same thing when I get a panic attack. In fact that is one of the first signs with me and then I feel like my throat is closing. I have never been to the dr. about them but my husband, who is a Paramedic, can usually talk me through it with no problem. And yes, it takes a very patient person to talk someone down.
 

HorseHauler

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especially his wife :ph34r:
 

BossyCow

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Why was the pt put on O2?
 

emtwannabe

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To give them something to focus on. If they are wearing a nasal cannula, they have to stop and concentrate on the O2.

Jeff
 

Ridryder911

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I treat panic attacks as a psychological event, in which it is. It is the reflection of the psyche that is being presented in a physical form.

I usually use reaffirmation, and allowing them to vent and discuss the feelings. I do however; may become firm and directive on some dependent on the situation. Many, feel that they have no control of the situation and need guidance.

Unfortunately, I believe a lot of the rise of "panic attacks" is increasing due to the "acceptance" of the inability coping skills. In severe cases, I will discuss with medical control and administer sedative or relaxants.

R/r 911
 

Tincanfireman

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Many times I've had hyperventilation/panic attack pt's complain of "not getting enough air". Some providers (not me) will put a NRB on the pt's face and crimp the O2 line, with the idea of fooling the person into thinking they are getting O2. Problem is, if the person realizes what has occurred, all credibility is lost. I agree, it's better to spend a few minutes trying to talk them down than to transport. But, if they really want to go it's their right. I just provide the means.
 

VentMedic

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Some providers (not me) will put a NRB on the pt's face and crimp the O2 line, with the idea of fooling the person into thinking they are getting O2.
That is not accepted practice and should not be done at any time!!

Hypoxia and hypercapnia will occur quickly and may result in a progression of unexpected events. In simple terms, suffocation by plastic.

The nasal cannula works much better until you can assess the patient. There may be more causing the rapid breathing then what you see initially. Assuming it is hyperventilation syndrome due to anxiety or hysteria may cause you to miss very valuable information.
 

Tincanfireman

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Agree, x 1000. Poor practice and I don't condone it, however, what others do is out of my hands. Kind of goes along with the hoary brown paper bag routine. It's shortcuts like this that end up in subpoenas!
 

bstone

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Why was the pt put on O2?
It never hurts to oxygenate. Hyperventilation is short, fasts breaths. Some believe that this doesnt allow for proper oxygenation. Increasing the amount of oxygen may help with symptoms.
 

jmaccauley

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There is an obvious psychological effect when administering oxygen to a patient suffering from panic or anxiety. Sometimes, putting anything around the face adds to the stress. In my profession (LEO), I often deal with folks who are stressed, panicked or just plain scared. I have them perform the same breathing exercises (combat breathing we call it) that I teach officers to perform when they find themselves getting too excited. Softly tell them to breathe in deeply for a count of 4, hold for a count of 4 and exhale on a count of 4. It works well as a temporary solution.
 

Ridryder911

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It never hurts to oxygenate. Hyperventilation is short, fasts breaths. Some believe that this doesnt allow for proper oxygenation. Increasing the amount of oxygen may help with symptoms.
I totally disagree with you. True hyperventillation symptoms is produced by respiratory alkalosis, (too much oxygenation) and thus applying oxygen on the patient actually potentates and may worsen the symptoms. (The carpopedal spasms, H/A, paresthesia around the lips, fingers, is caused by the pH level in the blood stream (review blood gases). The patient needs to rebuild the Co2 and yes, if one places a NRBM at 4 LPM or so, one can increase the Co2 level.

R/r 911
 

bstone

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I totally disagree with you. True hyperventillation symptoms is produced by respiratory alkalosis, (too much oxygenation) and thus applying oxygen on the patient actually potentates and may worsen the symptoms. (The carpopedal spasms, H/A, paresthesia around the lips, fingers, is caused by the pH level in the blood stream (review blood gases). The patient needs to rebuild the Co2 and yes, if one places a NRBM at 4 LPM or so, one can increase the Co2 level.

R/r 911
You disagree with placing the pt on a NRB at 4lpm? That's what I tried to say. Guess I wasn't clear. This is technically oxygenating, afterall, even tho it builds up CO2.
 

BossyCow

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I totally disagree with you. True hyperventillation symptoms is produced by respiratory alkalosis, (too much oxygenation) and thus applying oxygen on the patient actually potentates and may worsen the symptoms. (The carpopedal spasms, H/A, paresthesia around the lips, fingers, is caused by the pH level in the blood stream (review blood gases). The patient needs to rebuild the Co2 and yes, if one places a NRBM at 4 LPM or so, one can increase the Co2 level.

R/r 911
That's what I thought. I also agree with your comment that the best treatment for anxiety is one on one patient interaction. Playing that fine line between showing that you take their symptoms seriously and being an authority figure in control of the scene is what works best in the calls I've been on. If the patient gets even the slightest inkling that you think this is 'only psychological' things get a lot worse. I've had some luck with some patients in showing them the Pulse Ox reading and telling them the symptoms are from too much air instead of too little.. then the "Breathe with me... In.... Out... In... Out" routine. Keep them concentrating, eye contact on you while you coach them into slowing the breath down.
There are always going to be those so locked into it that they won't or can't work with you, but I've found these to be the exception rather than the rule.
 

MMiz

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Did I ever tell you the time when I was on an airplane, the guy has symptoms of an AMI, I put him on O2, and the bag didn't inflate? Yeah, no bag inflation = no O2. They tell passengers not to worry if the bag doesn't inflate only to falsely reassure them. I assure you, if the bag does not inflate, you are not getting O2.
 
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