Panic attack


  • Can occur de novo or in setting of psychiatric disorder (most commonly panic disorder)[1]

Clinical Features

  • Discrete period of intense fear or discomfort that peaks within a few minutes 'plus at least four of the following:[1]
    • Chest pain, palpitations
    • Dyspnea, feeling of suffocation
    • Diaphoresis, hot or cold flashes
    • Nausea
    • Trembling
    • Paresthesias
    • Fear of death, fear of losing control
    • Depersonalization
  • May feel the "urge to flee" or "sense of impending doom"

Differential Diagnosis

Acute dyspnea




  • Diagnosis of exclusion: must rule out organic causes of symptoms (see chest pain, palpitations, shortness of breath, etc.)
  • Clinical diagnosis, based on history and physical exam.


  • Reassurance and patient education
  • 1-2mg Lorazepam (Ativan) IV/IM


  • Discharge

See Also

  • Shortness of breath


  1. Foldes-Busque G, Denis I, Poitras J, Fleet RP, Archambault P, Dionne CE. A prospective cohort study to refine and validate the Panic Screening Score for identifying panic attacks associated with unexplained chest pain in the emergency department. BMJ Open. 2013;3(10):e003877. doi:10.1136/bmjopen-2013-003877.
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