Hyperventilation in Emergency Situations: Commonality, Diagnosis, and Management

Hyperventilation, while it may seem like a common occurrence, is typically diagnosed after ruling out other serious medical conditions. Emergency Medical Technicians (EMTs) and Paramedics are regularly dispatched to respond to calls related to hyperventilation, as it can mimic more severe conditions like asthma or heart problems.

Commonality of Hyperventilation Calls

It is not uncommon for EMT crews to be dispatched for someone experiencing hyperventilation. Hyperventilation can be a sign of anxiety, panic attacks, or other medical conditions (e.g., asthma, heart problems), leading to symptoms such as dizziness, tingling sensations, and shortness of breath. Since hyperventilation can mimic more serious conditions, EMTs often respond to ensure the individual's safety and provide appropriate care.

Emergency dispatch centers generally do not send out calls specifically mentioning hyperventilation as it is not enough to provide a definitive diagnosis. Hyperventilation syndrome is a clinically diagnosed condition based on medical history, respiratory rate, and blood gas readings, including normal-to-high oxygen tension and saturation, low carbon dioxide levels, and respiratory alkalosis. EMTs and Paramedics need to be cautious and rule out other possible conditions before concluding that hyperventilation is due to psychological causes.

Diagnostic Approach and Conditions to Rule Out

People experiencing hyperventilation syndrome typically call 911, stating they cannot breathe. The dispatch system responds to this complaint by dispatching EMTs/Paramedics. The external presentation of hyperventilation syndrome is often anxiety and rapid breathing, technically known as tachypnea or hyperpnea.

These rapid breathing patterns are common initial responses to various conditions, such as shock, heat stroke, hemorrhage, trauma, pain, metabolic derangements, toxicity, or cardiorespiratory problems. Therefore, before concluding that tachypnea or hyperpnea is the result of psychogenic hyperventilation, EMS providers must rule out the conditions causing compensatory tachypnea or hyperpnea.

Failing to properly diagnose a condition like pulmonary embolism, which has similar outward symptoms, can be highly dangerous. In many cases, erroneous diagnoses are due to insufficient training on the full scope of medical conditions presenting with similar symptoms. Education and a thorough understanding of the differential diagnoses are critical for preventing misdiagnosis and potential patient deaths.

Common Scenarios and Patient Groups

Hyperventilation syndrome is more common in certain demographics. In Southern California, teenage girls are frequently a group where hyperventilation calls arise, often due to pregnancy anxiety. However, the condition can occur in individuals of all ages and ethnicities, including Hispanic females and white female alcoholics. In one instance, a white female alcoholic hyperventilated so severely she appeared to be having seizures. Despite her SpO2 reading at 100%, her exhaled CO2 was remarkably low at about 17mmHg.

Interestingly, individuals from Iraq also exhibited a similar pattern of hyperventilation and emotional extremes. Understanding the psychological and physiological aspects of hyperventilation syndrome, such as its field expedient diagnosis, is crucial for EMTs and Paramedics in providing accurate and timely care.

Field Expedient Diagnosis of Alkalosis

While there is a complex pathophysiology involved in diagnosing hyperventilation, there are simple methods to determine alkalosis in the field. Alkalosis is a common symptom experienced by hyperventilating patients. EMTs can use a portable blood gas analyzer or get a rough estimate using the patient's blood pH level, which should be below 7.45. Another field expedient method involves monitoring the patient's respiratory rate and the end-tidal CO2 levels, which should be lower than the normal range of 35-45 mmHg.

Proper training and awareness of these symptoms are essential for EMTs and Paramedics to make an accurate and informed diagnosis, ensuring appropriate and timely care for patients presenting with hyperventilation.