Acute onset, hyperventilation, nausea and “tingling” extremities


• Scene – EKG, IV, coaching, CBG, VS

• En route – coaching

• Hospital – coaching


• Response to treatment – very slow to do what is asked of her. When she was distracted she would calm down a bit, but then get worked up again.

• Disposition – unknown


Elliot Williams, Paramedic Woodburn Ambulance

Ann Kuznetsov, Paramedic Woodburn Ambulance Service


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Hyperventilation
• Anxiety
• Panic attack

Differential Diagnosis

• Panic attack

• Hyperventilation

• Anxiety

• Aspirin overdose

• Depression

• Diabetic Ketoacidosis

Patient Workup History

• Patient states – she has had episodes like this before and she is not able to calm herself down. Her boyfriend told her to walk home and and “quit being lazy,” and that is when her panic attack started.

• Caregiver states – Aunt says that she has had some extra stress in her life recently

Physical Exam

• GCS – 15

• EKG – ST

• CBG – 115

• Tachycardia, tachypneic

Editor’s Notes

This illustrates one of the situations in EMS where often providers do not take the condition seriously. I have to emphasize this strongly with my students. There are two conditions at work here and both are very real and serious; anxiety (psychological disorder) and hyperventilation. Breathing in a bag may no longer be recommended – check protocols in your area for standards.

~ Melisa McNeil, M.H.S., EMT-P, Program Director of the Emergency Medical Care Program at Western Carolina University


• Gender: female

• Age: 17 years

• Height: Not Available

• Weight: Not Available


• Temperature: Not Available • Heart Rate: 128 • Respiratory Rate: 40+ • Pulse Oximetry: 98% RA • Blood Pressure: 116/90 Signs and Symptoms Hyperventilation; trembling; nausea. History Medical • PMH: Anxiety • Dispatch info: Difficulty breathing with tingling fingers. Social • Lives with aunt; mom just came back into her life the last couple of months. Medications • Hydroxyzine

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