Scenario:

It is 1000 hours in the emergency department (ED) when the ambulance brings in G.G., a 35-
year-old man who is having difficulty breathing. He complains of chest pain and tightness,
dizziness, palpitations nausea, paresthesia, and feelings of impending doom and unreality; he is
having trouble thinking clearly. He tells you, “I don’t think I’m going to make it. I must be
having a heart attack.” He is diaphoretic and trembling. His vital signs are 184/92, 104, 28, 98.4F
(36.9C). This episode began at work during a meeting at approximately 0920 and became
progressively worse. A co-worker called 911 and stayed with him until medical help arrived. The
patient has no history of cardiac problems.

1.What initial steps would you take and what orders would you expect to receive?

Case Study Progress: After a full medical workup, it is determined that G.G.’s condition is stable.
His shortness of breath and anxiety resolve after he is given lorazepam (Ativan) 1 mg IV push
(IVP). The lab work and ECG results are all within normal parameters and there is no evidence
of any physical disorder. A diagnosis or panic attack is made. G.G. admits to having had three

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similar episodes in the past 2 weeks; however, they were not nearly or severe or long-lasting.

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2.How do you think this diagnosis was determined?

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3.G.G. asks whether there is something wrong with his memory because he has been having
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trouble remembering things. What effect does panic disorder have on memory?
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Case Study Progress: G.G. shares with the ED staff that he has been under severe stress at work
and home. He tells them he is going through a divorce; he lost a child last summer in a motor
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vehicle accident, and his company is downsizing. He will probably be out of a job soon. He
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hasn’t been sleeping well for the past couple of months and has lost about 20 pounds.
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4.Identify five triggers that could cause anxiety to build to the point of panic.

5.G.G. has questions regarding the differences between panic attacks and panic disorder.
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According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V),
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what are the differences?

6.Has G.G. had an expected or unexpected panic attack? Explain your answer.
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Case Study Progress: G.G.’s condition is stable and the ED physician discusses what has
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happened with G.G. The physician gives G.G. a prescription for a “week’s worth” of medication
and instructs G.G. to see his primary care physician for further treatment and evaluation.

7.The physician gives G.G. a prescription for alprazolam (Xanax) 0.5 mg tid to last 1 week and
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instructs G.G. to see his primary care physician for further treatment and evaluation. Why do you
think the physician gave G.G. a prescription for only 1 week of Xanax?

8.What medications are used to treat panic attacks? What will your patient teaching include?

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 Case Study Progress: G.G. tells you all about his worries with his job and all that has happened
to him in the past year. He tells you that he appreciates you listening to him. He expresses fear
that the panic attacks will return.

9.What techniques to help him cope will you discuss with him? Name at least five.

10.What actions or interventions are most indicated in the treatment of panic disorder?

Case Study Outcome: G.G. makes an appointment with his company’s Employee Assistance
Program to take advantage of the resources offered for counseling to help him work with his
coping strategies. In addition, his primary care physician starts hum on a low dose of an SSRI.
After a few months, G.G.’s panic attacks have become very rare and he works on preparing a
resume to seek new employment before his company has another round of job cuts.

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