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Immediate stabilization
Initial priorities
Airway compromise signs
Stridor
Inability to speak full sentences
Breathing compromise signs
SpO2 < 94% on room air
Severe work of breathing
Circulatory compromise signs
SBP < 90 mm Hg
Altered mental status
If any instability, escalate to resuscitation bay
Continuous cardiac monitoring
Pulse oximetry
IV access
Immediate exclusions before labeling panic
Hypoglycemia
POC glucose
If < 3.9 mmol/l, treat per hypoglycemia protocol
Hypoxia
SpO2 trend
Supplemental oxygen if needed
Cardiac ischemia or arrhythmia
12-lead ECG within 10 minutes for chest pain or palpitations
Telemetry for recurrent symptoms
Pulmonary embolism or asthma exacerbation
Respiratory rate
Wheeze
Toxicologic or withdrawal syndromes
Stimulant exposure
Alcohol or benzodiazepine withdrawal risk
High-risk symptom pattern triggers
Red flag triggers
New focal neurologic deficit
Stroke pathway activation
CT head pathway if indicated
Syncope or near syncope
Cardiac syncope evaluation pathway
Orthostatic vitals if appropriate
Chest pain with exertion
ACS evaluation pathway
Troponin pathway
Persistent tachycardia > 130 beats/min
Sepsis, PE, arrhythmia evaluation
IV fluid consideration if dehydration
Fever
Infection evaluation
Substance induced hyperthermia evaluation
Key concepts
Panic attack framing
Abrupt surge of intense fear or discomfort
Peak within minutes
Prominent autonomic symptoms
Diagnosis of exclusion in first presentation
Medical mimics prioritized when atypical or high risk
Recurrent stereotyped episodes with prior workup increases likelihood
Hyperventilation physiology
Respiratory alkalosis
Paresthesias and carpopedal spasm
Chest tightness and lightheadedness
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.