Panic attack

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of episodes of ‍intense fearpanicanxiety

Onset ‍gradualsudden, ‍whileafter ‍

Severity is ‍mildmoderatesevere

Pattern ‍persistentintermittent

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Symptoms include:

‍anxiety

‍palpitations

‍sweating

‍shaking

‍shortness of breath

‍feeling of choking

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍chest discomfort

‍nausea

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍dizziness

‍fainting

‍heat sensations

‍tingling sensations on extremities

‍fear of losing control or going crazy

‍fear of dying

‍feeling of impending doom



Contributing factors:

‍major life stress

‍history of physical or sexual abuse

‍traumatic event

‍chronic cannabis use

‍stimulant use

‍excessive caffeine intake

no history of: ‍previous panic attacks, ‍anxiety disorders, ‍depression, ‍substance abuse, ‍post-traumatic stress disorder

no use of: ‍ADHD medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Panic attack ‍likelysuspectedpossible

DDx: panic attack, panic disorder, generalized anxiety disorder, social anxiety disorder, phobias, acute stress disorder, depression, bipolar disorder, cardiac arrhythmias, thyroid disorders, pulmonary embolism, myocardial infarction, gastroesophageal reflux disease, pheochromocytoma, substance-induced anxiety disorder, medication side effects, hypoglycemia, anaphylaxis, carcinoid syndrome, vasovagal syncope, somatic symptom disorder





PLAN:

Investigations:

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

- ECG

Treatments:

- ‍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

Further care:

- 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