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Panic Attack, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Characteristic, acute episodes of physical symptoms and intense fear that rapidly peak within 10 min and resolve in∼20 min

  • There may be a nonfearful variant in medical patients.

Panic Disorder

Diagnosis

Signs and Symptoms

  • Multiple systems suggest autonomic arousal

  • Cardiac:

    • Palpitations

    • Tachycardia

    • Chest pain or discomfort

  • Respiratory:

    • Shortness of breath

    • Smothering

    • Feeling of choking

  • Neurologic:

    • Tremo...

Treatment

Pre-Hospital

  • If diagnosis is supported by previous events, history and workup:

    • Reassurance and diversion

    • Does not require emergent care

  • If 1st episode, treat and transport as appropriate to pres...

Follow-Up

Disposition

Admission Criteria

  • As medically indicated to rule out organic cause

  • Meets criteria for psychiatric admission (suicidal, homicidal)

Discharge Criteria

Most panic attacks do not require...

Pearls and Pitfalls

  • Panic is “contagious.” Try not to be infected by the patient's sense of urgency to stop the symptoms; they will resolve spontaneously.

  • Be calm so as not to add to the patient's alar...

Additional Reading

  • Lader  M. Management of panic disorder. Expert Rev Neurother.  2005;5(2):259–266.

  • Lessard  MJ, Marchand  A, Pelland  MÈ, et al. Comparing two brief psychological interventions t...

Codes

ICD9

  • 300.01 Panic disorder without agoraphobia

  • 300.21 Agoraphobia with panic disorder

ICD10

  • F40.01 Agoraphobia with panic disorder

  • F41.0 Panic disorder without agoraphobia

SNOMED

  • 225624000 Panic attack...

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