When severe anxiety or a panic attack strikes, the physical symptoms can be so overwhelming they feel indistinguishable from a life-threatening medical event. The sudden onset of crushing chest pain, a racing heart, profuse sweating, and a frightening feeling of suffocation often leads people to seek emergency medical attention out of fear of a heart attack or pulmonary problem. Emergency Room (ER) staff understands that these complaints are genuine distress signals and, regardless of the suspected cause, they approach every presentation with the same goal: to rule out the most dangerous physical conditions first.
The Initial Triage and Stabilization Process
Your experience in the ER begins with triage, where a registered nurse performs a rapid assessment to prioritize your care. The nurse will immediately check your vital signs, including heart rate, blood pressure, respiratory rate, and oxygen saturation. Elevated heart rate (tachycardia) and high blood pressure are common manifestations of a panic state, but they must be documented and monitored carefully.
The primary objective during this initial phase is to establish medical stability and determine if you require immediate intervention to sustain basic life functions. The nurse will ask detailed questions about the onset, duration, and exact nature of your symptoms. Even if anxiety is strongly suspected, the staff is trained to quickly identify any red flags that would suggest an underlying physical issue.
Ruling Out Physical Causes Through Medical Testing
After the triage assessment, the medical team proceeds with diagnostic testing because the body’s physiological response to severe anxiety mimics several serious physical ailments. The intense release of stress hormones, such as adrenaline, can produce symptoms—like crushing chest pain or severe shortness of breath—that are identical to those of a cardiac event or a blood clot in the lung. Ruling out these possibilities is the first priority of emergency medicine.
An electrocardiogram (EKG) is a common test used to measure the electrical activity of your heart and detect acute cardiac abnormalities or signs of a heart attack. If chest pain is a prominent complaint, blood samples check for troponin, a protein released when the heart muscle is damaged. These cardiac enzyme tests require several hours to process and often necessitate repeat draws to confirm a negative result.
Basic blood work checks for physiological causes of anxiety-like symptoms. This includes a complete blood count (CBC) and a metabolic panel to check for electrolyte imbalances or low blood sugar (hypoglycemia). Thyroid function tests are frequently ordered, as an overactive thyroid gland (hyperthyroidism) can cause nervousness and a rapid heart rate. A toxicology screen identifies any substances, including illicit drugs or prescription medications, contributing to the acute symptoms.
Short-Term Treatment and Mental Health Consultation
Once physical causes for the symptoms are ruled out, the focus shifts to treating acute anxiety. Short-term pharmacological intervention is often used to break the cycle of panic and restore calm. The most common medication administered is a fast-acting anxiolytic, such as a benzodiazepine like lorazepam, which works quickly to slow the overactive central nervous system.
This medication is typically given orally or intravenously to provide rapid symptom relief. While the medication takes effect, the medical staff may also employ non-pharmacological techniques, such as coaching the patient through deep, controlled breathing exercises. These exercises help counteract the hyperventilation and respiratory alkalosis that often accompany a panic attack.
Following medical stabilization, an internal consultation is typically requested with a mental health professional, often a crisis counselor or a social worker. The consultant’s role is to conduct an immediate risk assessment, screening for thoughts of self-harm or suicide, not to provide long-term therapy. This professional evaluates your current support system and determines the safest path for discharge, ensuring you have appropriate resources.
Discharge Instructions and Follow-Up Care
When you are deemed medically stable and the mental health assessment confirms you are safe to leave, the ER team provides specific discharge instructions focused on preventing future visits. This typically includes a recommendation to schedule a follow-up appointment with your primary care provider or a mental health specialist within the next week. The goal is to establish long-term care for managing the underlying anxiety disorder.
If a fast-acting medication was used to stabilize you, the physician might provide a small, short-term prescription for a few days to help manage any residual or rebound anxiety. More importantly, the discharge paperwork will contain referrals to outpatient mental health services, such as a local therapist, a psychiatrist for medication management, or a community-based crisis center. You will also be provided with contact information for national or local crisis hotlines, which are intended to be the first point of contact should acute symptoms return before your follow-up appointments can be arranged.