Anxiety or Hyperventilation

Section 3 - RESPIRATORY

3.06 ANXIETY or HYPERVENTILATION

Hyperventilation Syndrome is a condition in which minute ventilation exceeds metabolic demands, resulting in hemodynamic and chemical changes that produce characteristic dysphoric symptoms inducing a drop in arterial pCO2 through voluntary rapid/deep respirations.

Hyperventilation signs and symptoms may include:

• Agitation, dyspnea, hyperpnea
• Wheezing and tachypnea
• Chest pain, palpitations
• Dizziness, paresthesias, generalized weakness, and syncope
• Tetanic cramps (eg, carpopedal spasm) and peri-oral numbness
• The patient often complains of a sense of suffocation
• An emotionally stressful precipitating event often can be identified

Procedures:

• Establish INITIAL MEDICAL CARE (2.01)
  • Obtain the patient's present medical history
• Before the patient is deemed to be hyperventilating the following must be identified and addressed:
  • Obtain baseline oxygen saturation and capnography
    • Oxygen saturation greater than 95% and CO2 of less than 30 mmHg present before initiating therapy
    • If available obtain a carbon monoxide reading
      • Must be less than 5% in non-smokers
      • Must be less than 10% in smokers
  • Rule out other triggering physical illnesses or conditions
  • Document the ABSENCE of a triggering physical event such as (but not limited to):
    • Smoke inhalation
    • Any significant or multi-system trauma
    • Chemical exposure or inhalation
    • No history of asthma, pneumonia or other respiratory illnesses
    • No history of previous pulmonary embolus or pulmonary edema
    • No previous cardiac or congestive heart failure conditions

Medical Care:

• Instruct the patient to breathe abdominally, using the diaphragm more than the chest wall, often leads to improvement in subjective dyspnea and eventually corrects many of the associated symptoms.
• Diaphragmatic breathing slows the respiratory rate, gives the patient a distracting maneuver to perform when attacks occur, and gives the patient a sense of self-control during the episode.
• If indicated have the patient use a paper bag placed gently over the mouth and nose to rebreathe his/her exhaled CO2.
  • When used, monitor closely for signs of hypoxia and continue monitoring oxygen saturation and CO2 levels
  • Limit the use of the paper bag to less than 5 minutes before interrupting and reassessing the patient’s condition.
  • May repeat twice at 5 minute intervals and reassessing the patient’s condition.

If the patient’s condition persists or worsens after treatment consider other etiologies that may be causing the event. Do not withhold oxygen from the patient!