A patient arrives at the emergency department in obvious emotional distress with perioral numbness and tachypnea. What should be the initial intervention?

A patient arrives at the emergency department in obvious emotional distress with perioral numbness and tachypnea. What should be the initial intervention?

• A. Send the client for a CT of the head.
• B. Place on 100% O2 per non-rebreathing face mask.
• C. Have the client breathe into a paper bag.
• D. Administer diazepam 2 mg IV push.

Answer: (C)

When someone is anxious and hyperventilating, they blow off CO2 faster than it’s produced, leading to respiratory alkalosis. That drop in CO2 and the resulting pH change cause symptoms like perioral numbness, tingling, and rapid breathing. The best initial step is to restore CO2 levels quickly, which is achieved by rebreathing some of the expelled air. Having the patient breathe into a paper bag increases the amount of CO2 they re-inhale, helping to correct the alkalosis and relieve the numbness and tachypnea. Sending the patient for a CT scan doesn’t address this acute breathing problem. Providing 100% oxygen doesn’t fix the underlying CO2 deficit and isn’t the targeted intervention here. Giving diazepam could suppress respiration and worsen the situation. If symptoms persist or other issues arise (hypoxia, altered mental status), reassessment and different management would be needed, but rebreathing into a bag is the most appropriate initial intervention for this presentation.

When someone is anxious and hyperventilating, they blow off CO2 faster than it’s produced, leading to respiratory alkalosis. That drop in CO2 and the resulting pH change cause symptoms like perioral numbness, tingling, and rapid breathing. The best initial step is to restore CO2 levels quickly, which is achieved by rebreathing some of the expelled air. Having the patient breathe into a paper bag increases the amount of CO2 they re-inhale, helping to correct the alkalosis and relieve the numbness and tachypnea.

Sending the patient for a CT scan doesn’t address this acute breathing problem. Providing 100% oxygen doesn’t fix the underlying CO2 deficit and isn’t the targeted intervention here. Giving diazepam could suppress respiration and worsen the situation. If symptoms persist or other issues arise (hypoxia, altered mental status), reassessment and different management would be needed, but rebreathing into a bag is the most appropriate initial intervention for this presentation.