Paralyzing Panic Attack

[telster]

Hyperventilation

Certainly sounds like the guy was hyperventilating, as diagnosed by the paramedic.

Just a word of warning about using the paper bag treatment. I've used it on people several dozen times and it normally does work, however its pretty frowned upon in medical texts now. The danger is that some of the symptoms of hyperventilation for example tightness of the chest, lightheadedness etc could be from something more sinister than a panic attack, and reducing the amount of oxygen being breathed in might be harmful if for example they are actually having a heart attack.

The advice now is to try and talk the patient into calming down, maybe counting through their breaths trying to slow them down. I've found that this can take longer than a paper bag to work, but is still effective. Difficult I realise if you are trying to fly an aircraft at the same time, and I don't mean any criticism for you giving a paper bag. I realise it is still advised in many first aid books, but it is now pretty outdated.

Pointers towards someone hyperventilating rather than anything more serious include that their colour might be pretty pink rather than pale or grey. Tingling around the mouth, and in the fingers. Hands and feet can tighten up into "carpo-pedal spasm", certainly the hands claw up fairly distinctively and its easily recognised once you've seen it. Skin tends to be drier than the classic heart attack and its profuse sweating (although not always the case).

Its actually the low carbon dioxide level in the blood that causes the symptoms, one thing it does is cause the bloodvessels in the brain to constrict causing lightheadedness and even the patient to eventually pass out. Once passed out, they relax and their breathing will slow and they will come to again. Hopefully they won't be quite so panicky when they come to or else the whole cycle could repeat itself. Oxygen levels have no relevance and it is quite safe, even recommended in some medical books, to give oxygen to someone who is hyperventilating. In the event that it isn't a panic attack then the oxygen might well be beneficial, and since the tissues of the brain are actually short of oxygen because of the blood vessels constricting then the supplemental oxygen might even help in a panic attack (in theory).

Some panic attacks are pretty obvious, other times it is quite hard to be certain about it. I've been pretty certain that people have been having heart attacks who I've eventually found out were just having panic attacks, hopefully I've never been caught out the other way.

Another word of warning is that I would guess that having a heart attack would be a pretty scary thing, so no guarantees that someone with a history of panic attacks is just having another one on this occasion.

So bottom line, rebreathing into a paper bag does help restore the carbon dioxide levels, but you'd better be pretty certain that a panic attck is all they're having.

Regards!

Telster
(Ex UK Paramedic)


Just read through the posts a little better and a couple of points need to be commented on.

Anaphylaxis, although always by definition a severe allergic reaction does come in different degrees. At one extreme the lips could be swelling up without any other real problems breathing, at the other the patient could be in cardiac arrest with a very few minutes. People do have anaphylaxis without any previous history of it and might not know what they are allergic to. After all, everyone with it at some point had their first ever attack. And onset isn't necessarily very rapid, it can be some considerable time after exposure to the allergen, even several hours. I've never seen it, but you even get exercise-induced anaphylaxis but I'm not too sure how that works (I've not been looking at wikipedia).

I wouldn't take feelings that someone is going to die as a pointer towards a panic attack. "Feeling of impending doom" was a symptom of a heart attack drummed into us when training, and there is a medical saying that if someone says they're going to kill themselves they almost certainly won't, and if someone says they're going to die then they very possibly will (and I've found that to be more often than not true).

All in all it sounds like the original poster did the exact right thing in getting down on the ground asap.