Artist Brad Siskin’s representation of a panic attack.

by James Hubbard, MD, MPH

Anyone preparing for a disaster needs to know what to do for a panic attack. We’re all susceptible during extreme stress. No matter how stoic or brave you are, it could happen, and for that period of time, you’re totally disabled. You can’t think straight or physically do much of anything.

Those of you who have experienced a panic attack (anxiety attack) know what I mean. If you haven’t, try to think of a time when you were most afraid, maybe it was just for a second, but you thought you were going to die. Now, imagine having that feeling for ten, fifteen minutes or more.

We’re not really sure what all goes into having a panic attack, but we think it has to do with your body going into its flight-or-fight mode, sometimes for no specific reason. And it seems some people’s bodies have lower trigger point than others.

Adrenaline and other hormones are released and increase your energy levels and heart rate. Your muscles tense, you sweat, you breathe fast, your thinking gets fuzzy. Now that’s great if you need to every iota of your energy focused on running away from or fighting a charging tiger, but for the average folks nowadays, it just wreaks havoc on your body.

Medical Treatment for Panic Attacks

If you’re having panic attacks now, there is good medical treatment available in addition to the paper-bag technique. A sedative like Xanax or Valium will provide immediate, short-term relief. Certain types of antidepressants can prevent attacks in the long-term.

Always try to rule out lung and heart problems by getting an oxygen level, EKG, chest X-ray, etc.

Your muscles may cramp, your chest ache; your feet, hands, and around your mouth may tingle, and you are just scared out of your wits. Many times, the fear is overwhelming. It’s often called a feeling of “impending doom.” You feel like you’re going to die and there’s nothing you can do about it. As a treating doctor, it’s often a difficult task to convince a person otherwise.

And if you’ve had one panic attack, you often live in fear you might have another because you never want to have that feeling again.

How Do You Know If It’s a Panic Attack?

Unless you’ve had one before and know the symptoms, you’re going to have to rule out other problems. This is important because the treatments are different, and one of the ways to relieve a panic attack (breathing into a paper bag) can make lung or heart problems worse.

You often can’t make the diagnosis with certainty without the proper diagnostic tests done in a medical clinic. One thing I’m going to start suggesting to add to your emergency kit is a pulse oximeter. You just slip it on the finger, and it measures the oxygen level in your blood. With a panic attack, your blood is getting plenty of oxygen, so if your oxygen level is, say, 94 or below, something else is going on. (Don’t use a paper bag.)

To see how much oxygen you’re getting, you can clip a pulse oximeter to your finger. (No needles, no blood.) If it reads about 94 or below, you’re not just dealing with a panic attack. There’s a heart or lung problem afoot. DON’T use that paper bag. (The picture is just an example, not a product recommendation.)

Here are some other tips to try to make an educated decision if there is no expert help available.

Think heart problems (heart attack, perhaps a sudden worsening of congestive heart failure) if:

    • The person is over forty-five years old.
    • The person has risk factors, like obesity, smoking, high blood pressure, high cholesterol, or a known history or family history of heart disease.
    • The heart rate is 150 or over (SVT).
    • The blood pressure is low.
Why That Paper Bag?

With a panic attack, you’re not breathing fast because you need more oxygen. You’re doing it because your fight-or-flight hormones have gone haywire.

With each breath, you blow out carbon dioxide. Usually that works out just right. But when you’re breathing too quickly, it messes up your body’s chemicals and the acid/base balance. That’s why your muscles cramp and sometimes spasm. That’s why your fingers and toes tingle, why you get dizzy. All those symptoms tend to make you more anxious and want to breathe more.

When you breathe into a bag, the carbon dioxide collects, and you breathe it back in. This can relieve your symptoms.

Some docs don’t think much of this CO2 theory. They think breathing in a bag works because you’re concentrating on doing that one thing. It takes your mind off your other symptoms, and you start relaxing. Whatever. If it works, it works.

Tips it could be the lungs (blood clot or spontaneous collapsed lung):

    • The person is wheezing.
    • The lips or area around them turn bluish.
    • The pulse oximeter shows an oxygen saturation below 95.
What to Do for a Panic Attack
  1. Try, try, try your best to calm down.
  2. Slow your breathing. Concentrate on slow, deep breaths.
  3. Breathe into a bag. Find a bag (I think a paper one works better), seal the opening around your mouth, and breathe. This replenishes your carbon dioxide balance. Don’t do this for more than a minute or two without taking some fresh-air breaths to make sure you’re getting enough oxygen. HOWEVER, if the diagnosis is wrong and you’re having lung or heart problems, carbon dioxide is not your issue. You need as much oxygen as fresh air can deliver. In those cases, breathing in a bag could make your condition worse. So how do you know? I’d follow my tips above.
  4. Or, better yet, learn breathing and relaxation techniques. Psychologists and respiratory therapist are good at teaching these. Use your stomach muscles to help you take in a deep breath, hold it for a few seconds, and blow it out with your mouth closed or through pursed lips. There are some techniques that require a certain instrument to help you train—best done by pulmonary therapists. Integrative-medicine doctor Andrew Weil describes some simpler ones here.

>> Got a wound but no doctor? Don’t panic! Pull up your handy The Survival Doctor’s Guide—ready when you are. <<

How to Prevent Panic Attacks
  1. If you can, go to a doctor to rule out medical causes such as thyroid disease, lung disease, and heart disease.
  2. There’s some evidence that supplemental zinc and magnesium can help.
  3. Treat underlying anxiety. More on that in the next post.


Painting and its photo by Brad Siskin, via Flickr.

Full disclosure: The picture of the pulse oximeter includes an affiliate link to If you buy anything through that link, someone who works on this site—not myself—gets a commission. As noted, the link is not meant as an endorsement, just an informational example.

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