Panic Attack

Today I worked from 1:00 pm to 12:00 am. I saw 5 different  patients with panic attacks / anxiety. Of course they do not show up complaining of "panic attacks", instead they say that the can't breath, they think they are having a heart attack, they feel like they are dying and they feel tingly / numb in their extremities. So I come into the room and have to try to sort things out. Is this a heart attack? Are they having an anaphylactic reaction to something? Usually we get an EKG to look at the heart and rule out an arrythmia we will look at cardiac enzymes to rule out MI. We also look at electrolytes and other blood work to help diagnose what is going on. Usually we can get to the diagnosis without all the tests but we have to do the tests "just in case". We give them ativan to calm them down and then talk to them about anxiety and treatment options. Usually just talking to them and helping them realize that they are not dying. Most of these patients have a history of anxiety and depression and are usually on medication for the anxiety / depression. While they are having the panic attack they really do feel like they are dying.