Neurological

Panic attack at AFL match

Foundation

Adult · 35yr · male

Patient Information

Dispatch	A 35YO male has walked into the FAP at Optus Stadium during an AFL match, visibly distressed and hyperventilating. (Daniel Hargreaves)
Patient	Daniel Hargreaves — 35yr (80kg)
Incident History	Pt states he was sitting in the stands watching the game when he suddenly felt his heart racing, couldn't catch his breath, and became convinced he was going to die. He walked to the FAP himself. No fall, no injury, no known medical cause identified by bystanders.
Emergency Contact	Chloe Hargreaves (Wife) — 0412 774 391

Initial Rapid Assessment

Response	Alert
Airway	Patent. Nil airway obstruction. Nil stridor or swelling. Speaking in short sentences.
Breathing	Rapid and shallow. RR elevated. No audible wheeze or crackles. Visible chest wall movement equal bilaterally. Patient reports sensation of not being able to get enough air despite adequate chest rise.
Circulation	Rapid and regular pulse. Skin flushed, diaphoretic. Nil external bleeding. Nil urticaria or rash.
Disability	GCS 15 (E4V5M6). Orientated to time, place and person. Highly anxious and distressed. Reported tingling in both hands and around mouth. Nil focal neurological deficit.
Exposure	Nil rash, nil urticaria, nil external injury. Dressed in AFL jersey and shorts. Nil medic alert bracelet visible.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	97% (RA)	Mild	28	114	138/88	<2s	15	4 4 ++	37.1	5.4 mmol/L	3
10 mins	98% (RA)	Nil	16	88	124/80	<2s	15	4 4 ++	37.1	5.4 mmol/L	1

History Taking

Treatment Response

Diagnosis

This patient is suffering from a panic attack, presenting with acute onset hyperventilation, palpitations, chest tightness, perioral and bilateral hand tingling (consistent with hypocapnia from hyperventilation), diaphoresis, and a sense of impending doom in the context of a crowded, high-stimulation environment. Organic causes including hypoglycaemia and anaphylaxis have been excluded by assessment.

Facilitator Triggers — if trainees miss a critical step

! (If trainees do not perform a BGL within the first 3 minutes, Daniel begins to look more confused and asks 'am I dying?' — prompt the trainee to consider and exclude hypoglycaemia as an organic cause for altered behaviour.)
! (If trainees do not reassure the patient and attempt de-escalation within 2 minutes of contact, Daniel's breathing rate increases to 34 and he starts to feel numbness in his fingers — prompt: 'the patient is getting more distressed, what are you going to do first?')
! (If trainees immediately reach for oxygen without assessing SpO2, ask them to justify: 'what are Daniel's saturations on room air and what is your target range?' — SpO2 97% RA does not meet the threshold for supplemental oxygen administration.)
! (If trainees fail to consider and exclude anaphylaxis given rash/hives are absent and there is no known allergen exposure, facilitator should prompt: 'what two body systems would you need to see involved to consider anaphylaxis?')
! (If trainees do not take a full SAMPLE history including pertinent cardiac history and medications, facilitate patient to mention 'my dad had a heart attack at 50' to prompt the trainee to consider and document this but continue to assess clinically.)

Treatment Objectives

1. Ensure scene safety and don appropriate PPE including gloves.
2. Perform Primary Survey — confirm patent airway, assess breathing rate and quality, assess circulation, assess GCS and neurological status.
3. Perform Vital Sign Survey — obtain SpO2, RR, HR, BP, BGL, temperature, PERL.
4. Perform BGL — result 5.4 mmol/L, within normal range. Document and exclude hypoglycaemia as organic cause.
5. Assess SpO2 — 97% on room air. Oxygen is NOT indicated as SpO2 meets target range of 94–98%. Do not administer supplemental oxygen.
6. Conduct thorough history taking using SAMPLE/IMISTAMBO framework — signs and symptoms, allergies, medications, pertinent history, last oral intake, events leading.
7. Apply RASS score following initial de-escalation attempt — expected RASS +1 to +2 (restless to agitated but not violent).
8. Perform de-escalation as primary intervention — calm, quiet reassurance in a low-stimulation area of the FAP. Use a non-confrontational, measured tone. Maintain appropriate personal space.
9. Coach patient through slow, controlled breathing — instruct patient to breathe in slowly through the nose for 4 counts, and out through the mouth for 4 counts. Remain with patient throughout.
10. Perform Secondary Survey and CNS Survey to exclude organic and trauma-related causes for presentation.
11. Reassess vital signs at 10 minutes — expect improvement: RR 16, HR 88, SpO2 98% RA, BP 124/80, GCS 15.
12. Reassure patient that symptoms are consistent with a panic attack and are not life threatening. Explain what a panic attack is in simple terms.
13. Document all findings, observations, and interventions on ePCR.
14. Advise patient to follow up with his GP for review and ongoing management of anxiety.
15. Offer patient the option of transport to hospital for further assessment — document informed decision if patient declines.
16. Scenario ends on arrival of ambulance and IMISTAMBO handover.
17. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Disturbed & Abnormal Behaviour · Transient Loss of Consciousness (Fainting / Syncope) · Hypoglycaemia · Anaphylaxis · Primary Survey · Glasgow Coma Scale (GCS) · Blood Glucose Monitor · Pulse Oximetry · Pain Assessment

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Signs/Symptoms	Palpitations, shortness of breath, tingling in hands and around mouth, chest tightness, dizziness, sense of impending doom, diaphoresis.
Allergies	NKDA.
Medications	Nil regular medications.
Pertinent History	No known cardiac history. No known respiratory conditions. No previous episodes. No family history of cardiac disease. Denies any drug or alcohol use today. No recent illness.
Last Oral Intake	Ate a meat pie and drank one beer approximately 1 hour ago.
Events Leading	Watching the AFL game in the stands. States the crowd was very loud and packed. Began to feel hot and crowded before symptoms started.
Treatment Prior	Nil. A bystander told him to breathe into a paper bag but he declined.

Onset	Sudden onset approximately 15 minutes ago while seated in the stands watching the game. No clear precipitant identified by patient.
Pain	Chest tightness rated 3/10. Non-exertional. No radiation. Not described as crushing or squeezing.
Quality	Tight sensation across chest, feels like heart is pounding out of his chest.
Radiates	Nil radiation to arm, jaw or back.
Severity	3/10 chest tightness. Reports overall distress as 8/10.