Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Panic symptoms with possible physiological crisis
Chest pain, syncope, cyanosis, stridor, unilateral chest signs, fever, haemoptysis, exhaustion or altered consciousness cannot be attributed to panic without urgent assessment.
Action: Use ABCDE assessment and treat hypoxaemia, bronchospasm, embolism, pneumothorax, infection, arrhythmia or opioid toxicity as indicated. Stay calm and coach paced breathing in parallel; once immediate danger is addressed, assess panic, capacity, suicidal risk and the person's agreed escalation plan.
Synopsis
Recognise the reciprocal breathlessness-panic cycle without overlooking respiratory emergencies, teach immediate recovery skills, address illness understanding and avoidance, and use psychological or pharmacological treatment according to onset, goals and respiratory safety.
Validate the sensation without assuming its cause: panic can intensify breathlessness, and respiratory pathology can trigger genuine panic simultaneously.
First-line crisis care is presence, upright supported posture, cool facial airflow, one calm speaker and a slow exhalation-focused breathing pattern.
Use short grounding prompts: name what is happening, orient to the room, relax shoulders and match activity to a safe recovery position.
Key red flags
A first or changed panic-like episode with hypoxaemia, focal signs, pleuritic pain, haemoptysis or syncope requires urgent cardiopulmonary evaluation.
Sedative accumulation
Slurred speech, unsteady gait, prolonged sleep and slowed breathing after rescue use indicates medicine harm rather than successful calming.
Investigation priorities
01
First-line episode safety assessmentFirst stepFirst line
Check airway, respiratory rate and effort, saturation, pulse, pressure, temperature, consciousness, chest and relevant embolic or cardiac features.
Management branches
Typical panic crisisReduce threat and restore efficient breathing
A familiar breathlessness-panic episode occurs without new emergency features.
Stay with the patient, use one calm speaker, supported posture and facial airflow and guide a gentle prolonged exhalation without demanding deep breaths.
Name and validate the fear, use grounding and administer only a pre-agreed patient-specific rescue when the non-drug sequence is insufficient.
Key medicines
Lorazepam rescue for severe panicUse 500 micrograms orally or sublingually as a patient-specific as-needed dose under the local palliative protocol, with a written minimum interval and maximum action plan; lower exposure may be needed in frailty or hepatic impairment.
Sertraline for persistent panic or anxietyStart 25 mg orally once daily when sensitivity or frailty warrants, increasing to 50 mg once daily after about one week if tolerated, with later BNF-guided titration and review.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.