Anxiety or Hyperventilation

Section 3 - RESPIRATORY

3.06 ANXIETY / 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.