Paramedics Course – Hyperventilation

Hyperventilation – Panic Attacks

Micro Lecture by the Australian Paramedical College:

This micro lecture is about anxiety attacks, panic attacks/anxiety disorders and hyperventilation. Enrolled students have unlimited access to a rich library of learning materials such as this.

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In today’s micro-lecture we’re going to talk about anxiety attacks, or panic attacks, or anxiety disorders, whichever one you want to call it. Now, you are going to be called to somebody who’s experiencing an anxiety disorder, or anxiety attack at some point in your career.

There’s currently little known about the actual triggers. We do know that in the literature, that there’s different generalised causes such as anxiety, or maybe depression, and other psychopathies, some types of brain lesions, and head injuries, but the actual trigger is still unknown from a very specific cellular viewpoint. We don’t know why there is this imbalance between the respiratory gases.

When you arrive on scene of somebody having anxiety disorder, it’s so important that you have a general level of understanding, and not immediately go in to judge the patient. Typically, you’re going to be spending time going to people who are younger, people in their early 20s, female.

Just because you’re attending that demographic, it doesn’t mean … they’ve called you, they’ve called 000, because they can’t control their breathing, and on many occasions they actually will leave it till the very last minute before calling you.

Regardless of the demographic, or the cause, or the age, or the gender, as the paramedic, it really is your role to go in without prejudging, to have a level of understanding that allows you to effectively treat that patient with lots of reassurance, lots of communication, because that’s what this patient is going to require.

What you also have to understand, is that anybody who’s hyperventilating, in other words, tachypneic, lots of breathing fast, they are going to eventually end up with a state of metabolic and respiratory alkalosis. That might not mean a lot to you, but when we’re talking about the acid based balance, the blood must be maintained … be between 7.35 and 7.45.

In other words, breathing fast is not going to do the acid levels in your blood very good, it’s going to blow it off and make it alkaline, so the CO2 will all be blown off, and you’ll end up with a state of alkalosis which is actually very, very toxic and put you into cardiac arrest.

The messages at this point are to have a level of understanding, communicate with your patient, and to not prejudge. When you’re treating this patient, we used to tell our patients to breathe into brown paper bags so they can breathe their own CO2. Paramedics were well-placed to give your patient an oxygen mask to breathe into as well, but that doesn’t happen anymore.

It shouldn’t happen. Instead, what we need to be doing, is coaching the breather by being assertive with your patient, by saying, “You need to listen to me. Try slowing your breathing down, we’re going to do this together.” What I’ve found has been effective before in the past, is tactile communication, hand on the shoulder. Telling your patient to take a nice, deep breath in through the nose, holding it for three seconds, one, two, three, and out through the mouth, and repeating that for approximately 10 times.

So that’s a micro-lecture on ventilation, for hyperventilation. My name’s Sam (from the Australian Paramedical College). It’s been great talking to you, and I look forward to talking to you again shortly.

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