›Immediate stabilization
›Cardiac monitor when chest pain, palpitations, syncope, or abnormal vitals
›Pulse oximetry
›IV access if abnormal vitals or significant distress
›If SpO2 < 92%, oxygen and alternate diagnosis workup
›Rapid rule out triggers
›If chest pain concerning for ischemia, ECG within 10 minutes
›If hypoglycemia suspected, point of care glucose immediately
›If severe agitation with hyperthermia, toxidrome pathway
›Non pharmacologic measures
›Quiet room and reduced stimulation
›Coached slow breathing
›Grounding technique prompt
›Pharmacologic options when needed
›Hydroxyzine PO 25 mg
›Repeat 25 mg in 6 hours as needed
›Avoid with significant QT prolongation
›Lorazepam PO or SL 0.5 mg
›Repeat 0.5 mg in 30 to 60 minutes as needed
›Avoid in intoxication with other sedatives
›Lorazepam IV 0.5 mg
›Indication
›Severe panic with inability to take PO
›Severe agitation without toxidrome features
›Monitoring
›Respiratory rate
›Sedation level
Diagnostic plan and sequencing
›Targeted testing
›ECG based on triggers
›Glucose based on triggers
›Pregnancy test when applicable
›Avoid overtesting when low risk
›Normal vitals and classic panic features
›No cardiopulmonary red flags
›Time window reassessment
›Recheck vitals in 15 to 30 minutes after intervention
›Repeat focused cardiopulmonary exam if dyspnea or chest symptoms persist
›Escalation logic
›If symptoms persist with abnormal vitals, broaden medical workup
›If new neurologic findings, neuro pathway