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You are seeing a 16-year-old boy who was walking home from school when he experienced sudden onset of intense dread, racing heartbeat, dizziness, difficulty breathing, tingling in his fingertips, and trembling. His friend called 911 and he was brought in by ambulance. Although many of his symptoms have improved, he remains nervous-appearing and mildly tremulous. He denies any drug intake or intake of other substances, supplements. He does not recall thinking about anything stressful prior to his symptom onset. Vital signs are temp 37.6, HR 90, RR 20, BP 110/60, O2 sat 99% on room air. His physical and neurologic exams are normal.
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March 5, 2024 at 5:43 pm
B) SSRI
The symptoms described are consistent with a panic attack. Panic attacks generally begin abruptly, and the patient may not be able to identify any trigger. Although benzodiazepines are sometimes given acutely in the ED if the patient is still significantly symptomatic despite calming measures, the first-line pharmacotherapy treatment for this condition (if cognitive behavioral therapy alone does not suffice) is an SSRI.