Browse categories and answer follow-up questions to refine your symptom profile.
History
Symptom characterization
Symptom pattern
Episodic panic attacks
Persistent generalized anxiety
Situational or trigger specific anxiety
Post event acute anxiety
Time course
Onset time and speed of escalation
Peak intensity timing
Duration of episodes
Frequency over past 24 hours and past week
Triggers and context
Emotional stressor
Social performance situation
Trauma reminder
Substance or medication change
Sleep deprivation
Associated symptoms
Chest pain or chest pressure
Dyspnea or air hunger
Palpitations
Dizziness or presyncope
Tremor
Diaphoresis
Nausea
Paresthesias
Chills or hot flushes
Derealization
Depersonalization
Fear of dying
Fear of losing control
Functional impact
Ability to attend school or work
Avoidance behaviors
Sleep disruption
Nutrition and hydration disruption
Psychiatric and safety history
Psychiatric symptom context
Prior panic attacks
Generalized anxiety disorder history
Depression symptoms
Trauma related symptoms
Substance use symptoms
Safety screen
Current thoughts of death
Current thoughts of self harm
Current thoughts of harming others
Access to weapons or medications at home
Baseline supports
Trusted adult available
Safe place to go tonight
Ability to follow up within 72 hours
Alarm Features
Immediate life threats to exclude
Cardiopulmonary red flags
Chest pain with exertion
Syncope
New focal neurologic deficit
Hemoptysis
New hypoxia
Toxicologic red flags
Agitation with hyperthermia
Severe tremor or clonus
Severe hypertension with end organ symptoms
Severe tachycardia with altered mental status
Endocrine and metabolic red flags
Hypoglycemia symptoms with diaphoresis and confusion
Thyrotoxicosis symptoms
Adrenal crisis risk with hypotension
Pregnancy related red flags
Positive pregnancy with chest pain or dyspnea
Positive pregnancy with syncope
Postpartum status within 6 weeks
Vital sign danger thresholds
High risk vitals
SpO2 < 92% on room air
SBP < 90 mmHg
HR > 130 bpm sustained
RR > 30 per minute
Temperature >= 38.5 C with toxicity
Escalation triggers
Persistent abnormal vitals after calming measures
Progressive respiratory distress
New confusion or reduced level of consciousness
Medications
Medication reconciliation
Psychotropic medications
SSRI
SNRI
Bupropion
Antipsychotic
Mood stabilizer
Anxiolytics and sedatives
Benzodiazepine
Hydroxyzine
Gabapentin
Cardiorespiratory medications
Beta blocker
Bronchodilator
Decongestant agents
Recent changes
Dose increase within past 2 weeks
Dose decrease within past 2 weeks
Abrupt discontinuation within past 2 weeks
High risk medication effects and interactions
Activation and akathisia risk
SSRI and SNRI initiation
Antipsychotic associated akathisia
Serotonin syndrome risk exposures
SSRI or SNRI plus MAOI
SSRI or SNRI plus linezolid
SSRI or SNRI plus triptan
Stimulant and sympathomimetic exposures
ADHD stimulant
Pseudoephedrine
Caffeine tablets
Diet
Intake and exposures
Caffeine and stimulants
Coffee
Energy drinks
Pre workout supplements
Hydration and nutrition
Reduced oral intake
Vomiting or diarrhea
Alcohol exposure
Recent use within 24 hours
Withdrawal risk within 6 to 24 hours after last drink
Review of Systems
Cardiopulmonary
Cardiopulmonary symptoms
Chest pain
Dyspnea
Palpitations
Orthopnea
Pleuritic pain
Wheeze
Cough
Fever
Neurologic and endocrine
Neurologic symptoms
Syncope
Presyncope
Headache
Seizure activity
Weakness
Speech change
Endocrine symptoms
Heat intolerance
Weight loss
Tremor
Polyuria
Polydipsia
Collateral History and Family History
Collateral sources
Source and reliability
Parent or guardian report
Partner or friend report
EMS report
School report
Family history
Psychiatric and cardiac history
Anxiety disorders
Bipolar disorder
Sudden unexplained death under age 40
Known inherited arrhythmia syndrome
Risk Factors
Medical and exposure risks
Cardiopulmonary risk factors
Known congenital heart disease
Known arrhythmia
Prior venous thromboembolism
Hormonal contraception exposure
Substance and withdrawal risks
Cannabis
Cocaine
Amphetamine or methamphetamine
Alcohol withdrawal risk
Social and environmental risks
Recent trauma exposure
Bullying or interpersonal conflict
Housing insecurity
Differential Diagnosis
Life threatening
Life threatening causes of anxiety like symptoms
Acute coronary syndrome (I21.9)
Exertional chest pain
Diaphoresis with chest pressure
Pulmonary embolism (I26.99)
Pleuritic chest pain
Hypoxia
Risk factors for venous thromboembolism
Cardiac arrhythmia (I49.9)
Palpitations with syncope
Family history sudden death
Severe asthma exacerbation (J45.901)
Wheeze
Accessory muscle use
Hypoglycemia (E16.2)
Diaphoresis with confusion
Low point of care glucose
Sepsis (A41.9)
Fever with tachycardia and toxicity
Hypotension
Serotonin syndrome (T43.205A)
Hyperreflexia
Clonus
Hyperthermia
Common
Common diagnoses
Panic attack (F41.0)
Sudden onset peak within minutes
Autonomic symptoms
Generalized anxiety disorder (F41.1)
Excessive worry most days
Sleep disturbance
Medication induced anxiety (F19.980)
Stimulants
Decongestants
Caffeine related anxiety (F15.980)
High intake
Temporal relationship
Less common and mimics
Less common diagnoses and mimics
Thyrotoxicosis (E05.90)
Heat intolerance
Weight loss
Pheochromocytoma (D35.00)
Paroxysmal headache
Paroxysmal hypertension
Hyperventilation syndrome (R06.4)
Perioral tingling
Carpopedal spasm
Somatic symptom disorder (F45.1)
Multiple recurrent presentations
Excessive health related anxiety
Past Medical History
Relevant conditions and prior episodes
Prior diagnoses and events
Anxiety disorders
Depression (F32.9)
Asthma (J45.909)
Diabetes mellitus (E10.9, E11.9)
Thyroid disease (E03.9, E05.90)
Prior similar episodes
Prior ED visits for panic symptoms
Prior admissions for cardiopulmonary complaints
Physical Exam
General and vitals
General assessment
Appearance calm versus distressed
Work of breathing
Diaphoresis
Vital sign interpretation
Persistent tachycardia after calming
Hypoxia
Fever pattern
Cardiopulmonary and neurologic
Cardiovascular
Regular versus irregular rhythm
New murmur
Respiratory
Wheeze
Crackles
Prolonged expiratory phase
Neurologic
Mental status and orientation
Focal deficits
Tremor
Hyperreflexia
Clonus
Toxicologic and endocrine clues
Toxidrome features
Mydriasis
Diaphoresis
Agitation
Thyroid features
Goiter
Lid lag
Warm moist skin
Lab Studies
Core tests based on presentation
Point of care glucose
Indication
Altered mental status
Diaphoresis
Pregnancy test when applicable
Indication
Any patient with pregnancy potential
Abdominal pain
CBC
Indication
Fever
Suspected infection
Electrolytes and renal function
Indication
Vomiting or diarrhea
Diuretic use
TSH with reflex free T4
Indication
Persistent tachycardia
Tremor
Weight loss
Toxicology testing
Indication
Suspected intoxication
Unexplained agitation
Cardiac and pulmonary testing triggers
Troponin
Indication
Chest pain concerning for ischemia
Abnormal ECG
D dimer
Indication
Low to intermediate pretest probability pulmonary embolism
No high risk features
Venous blood gas
Indication
Severe dyspnea
Concern for metabolic derangement
Imaging
Scoring Systems
Pretest probability tools
Wells criteria for pulmonary embolism
PERC rule
HEART score for chest pain
Use and limits
Not for hemodynamically unstable patients
Local protocol dependent pathways
MRI
MRI indications
Focal neurologic deficit
Concern for intracranial pathology after initial evaluation
MRI cautions
Implanted devices compatibility
Need for sedation considerations
CT
CT chest angiography
Indication
Suspected pulmonary embolism with positive pathway criteria
Hypoxia with pleuritic symptoms and risk factors
Cautions
Contrast nephropathy risk
Contrast allergy history
CT head
Indication
New focal neurologic deficit
Altered mental status not explained by panic
Ultrasound
POCUS cardiopulmonary
Indication
Dyspnea with unclear cause
Suspected pneumothorax
Interpretation pitfalls
Artifact mimics
Operator dependent limitations
Special Tests
Bedside physiologic assessment
Capnography when available
Low end tidal CO2 support for hyperventilation
Persistent abnormal end tidal CO2 prompts alternate diagnosis
Peak expiratory flow
Baseline comparison when known
Low value supports asthma exacerbation
Orthostatic vitals
Suspected dehydration
Presyncope with volume loss
ECG
Indications and interpretation
ECG indications
Chest pain
Palpitations
Syncope or presyncope
Persistent tachycardia
High risk findings
Ischemic ST segment changes
QT prolongation
Preexcitation
Ventricular ectopy
Assessment
Working diagnosis and risk stratification
Panic attack versus anxiety disorder
Sudden onset peak within minutes supports panic attack (F41.0)
Persistent worry most days supports generalized anxiety disorder (F41.1)
Medical mimic exclusion status
Normal oxygenation and exam
Normal ECG when indicated
Normal glucose
Severity stratification
Mild
Moderate
Severe with impaired function
Severe with safety concerns
Special populations
Pediatrics and adolescents
Substance exposure screening relevance
School stressors and bullying relevance
Pregnancy
Pulmonary embolism risk context
Medication selection cautions
Older adults
Higher baseline cardiopulmonary mimic risk
Medication adverse effect risk
Plan
First 5 minutes workflow
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
Symptom control
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
Reassessment loop
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
Disposition
Level of care criteria
ICU criteria
Persistent hypoxia
Hemodynamic instability
Severe toxidrome features
Inpatient admission criteria
Medical etiology identified requiring treatment
Persistent inability to function with ongoing severe symptoms
Observation criteria
Chest pain workup pathway
Persistent tachycardia needing serial evaluation
Discharge criteria
Symptoms improved
Normalized vital signs
Medical mimics addressed as indicated
Safe supervision and follow up plan
Follow up timing
Outpatient follow up
Primary care within 1 to 2 weeks
Mental health follow up within 1 week when available
Same week follow up for new medication initiation
Discharge Instructions
Copy discharge instructions
Summary
Today your symptoms fit best with anxiety or a panic attack after testing and exam did not show an emergency medical cause.
Symptoms can feel intense and scary but are not usually dangerous when serious causes have been ruled out.
Medications
Take medications only as prescribed.
Avoid alcohol, cannabis, and other drugs that can worsen anxiety.
Avoid caffeine and energy drinks for the next 48 hours.
Self care
Use slow breathing during symptoms.
Use grounding techniques during symptoms.
Maintain hydration and regular meals.
Follow up
Arrange follow up with your clinician within 1 to 2 weeks.
Arrange mental health follow up within 1 week if available.
Return to emergency care now if
Chest pain that is new or severe
Trouble breathing
Fainting
New weakness
New confusion
Fever with worsening symptoms
You feel unsafe at home
References
Guidelines and evidence
Guideline references
NICE guideline, Generalised anxiety disorder and panic disorder in adults, 2011, updated
American Psychiatric Association, Practice guideline for the treatment of patients with panic disorder, updated
World Health Organization, mhGAP Intervention Guide, anxiety disorders section, updated
American Heart Association and American College of Cardiology, chest pain guideline, 2021
ACEP clinical policies and decision tools for suspected pulmonary embolism, local protocol dependent
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.