Panic attack

HISTORY:

Episodes of ‍intense fearpanicanxiety for ‍ ‍hoursdays

Onset: ‍gradualsudden, following ‍

Severity: ‍mildmoderatesevere

Pattern: ‍constantintermittent

Worsening factors: ‍none

Treatments tried: ‍none, ‍effectiveineffective

‍anxiety

‍palpitations

‍sweating

‍shaking

‍shortness of breath

‍feeling of choking

‍chest pain

‍chest discomfort

‍nausea

‍abdominal pain

‍dizziness

‍fainting

‍heat sensations

‍tingling sensations on extremities

‍fear of losing control or going crazy

‍fear of dying

‍feeling of impending doom



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Throat: ‍normalrednessexudate

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍no rash

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍

Neurologic: cranial nerves ‍normal, strength ‍5/5 throughout, sensation ‍normal, reflexes ‍2+ throughout, cerebellar function ‍normal, gait ‍stable

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought process ‍organized, ‍no suicidal ideation, judgment ‍good



ASSESSMENT:

‍Panic attack ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍TSH, ‍glucose

- ECG

- ‍Benzodiazepines

- ‍SSRIs

- ‍Beta-blockers

- Cognitive behavioral therapy

- Mindfulness and relaxation techniques

- Regular exercise

- Good sleep hygiene

- Avoidance of caffeine and other stimulants

- Avoidance of alcohol

- Avoidance of cannabis

- Avoidance of drugs

- Referral to psychologist

- Referral to psychiatrist

- Follow-up in ‍ ‍daysweeksmonths

- Return if symptoms worsen or if new symptoms develop such as chest pain, shortness of breath, or suicidal thoughts