A panic attack is a sudden surge of intense fear or discomfort that reaches a peak within minutes. Symptoms include a pounding heart, accelerated heart rate, sweating, trembling, and shortness of breath. Because these physical sensations can feel so severe and mimic serious medical conditions like a heart attack, seeking emergency care is a responsible decision. ER staff are trained to manage mental health crises and prioritize determining the cause of your distress.
Initial Triage and Intake
Your visit begins at the triage desk, where a healthcare professional assesses the urgency of your condition to prioritize treatment. This initial assessment involves checking basic vital signs, which include heart rate, blood pressure, respiratory rate, and oxygen saturation. A panic attack can significantly elevate heart rate and blood pressure, so these measurements help the staff understand the physiological impact of your current state.
The triage nurse will also conduct a brief but focused medical history, asking about the onset and nature of your current symptoms, especially concerning chest pain, difficulty breathing, or dizziness. They will inquire if this is your first experience of these symptoms or if you have a history of panic attacks or anxiety. Even with a suspected panic attack, the primary goal at this stage remains to identify and rule out any immediate, life-threatening medical emergencies.
Diagnostic Testing to Exclude Medical Causes
The ER focuses on a “diagnosis of exclusion,” systematically ruling out serious physical illnesses that present like a panic attack. Conditions such as a heart attack (myocardial infarction), an overactive thyroid (thyroid storm), or a blood clot in the lung (pulmonary embolism) can all cause chest pain, palpitations, and shortness of breath. Since the symptoms are nearly identical, the medical team acts to protect you by investigating the most serious possibilities first.
An Electrocardiogram (ECG or EKG) records the electrical activity of the heart to check for rhythm abnormalities or signs of cardiac distress. Blood work is also routinely ordered, which may include tests for cardiac enzymes like Troponin to exclude heart muscle damage, and a check of thyroid-stimulating hormone (TSH) to rule out hyperthyroidism. A blood glucose test may also be performed to ensure the symptoms are not the result of hypoglycemia, which can also trigger anxiety-like symptoms.
The blood analysis may also include a complete blood count (CBC) and a comprehensive metabolic panel (CMP) to look for signs of anemia, infection, or electrolyte imbalances. For patients experiencing significant shortness of breath, a D-dimer assay may be drawn to assess the likelihood of a pulmonary embolism. These comprehensive tests provide objective data necessary before confirming the experience as purely a panic attack.
Stabilization and Symptom Management
Once the medical team is confident that your symptoms are not caused by a physical illness, they focus on calming the acute panic and restoring a state of equilibrium. Non-pharmacological interventions are often the first line of care and involve creating a quiet, low-stimulus environment to help reduce sensory overload. Nurses or physicians may guide you through controlled breathing exercises, which can help correct the hyperventilation often associated with a panic attack.
Staff provide reassurance and psychoeducation, helping you understand that the intense physical sensations are temporary and not life-threatening. If the attack is severe and non-pharmacological methods are insufficient, the ER physician may administer a fast-acting anti-anxiety medication. Benzodiazepines, such as lorazepam, are commonly used because they have a rapid onset of action, often administered intravenously or intramuscularly for immediate effect.
These medications work by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain, which helps to quickly slow down the overactive nervous system and break the acute panic cycle. The goal of this pharmacological intervention is solely to achieve immediate stabilization and alleviate the distressing symptoms. Long-term treatment is not initiated in the ER due to the potential for dependency with this class of drugs.
Planning for Ongoing Care
After the acute panic attack has resolved and you are medically stable, the focus shifts to preventing future episodes and managing underlying anxiety. The emergency department visit serves to manage the crisis, but it is not a substitute for continuous mental health treatment. Discharge planning involves providing you with clear instructions and resources for follow-up care.
You will typically receive referrals to a primary care physician who can manage long-term medication, or directly to mental health specialists, such as a psychologist or psychiatrist. The discharge papers often include information on local mental health clinics, crisis hotlines, and support groups. This step ensures a smooth transition from crisis intervention to sustained therapeutic care.
The ER staff will emphasize the importance of making and keeping follow-up appointments to address the root causes of the panic attacks. Ongoing treatment often involves psychotherapy, like cognitive behavioral therapy (CBT), or a long-term medication regimen, such as a Selective Serotonin Reuptake Inhibitor (SSRI). Providing this bridge to future care is the final function of the ER visit.