A 45-year-old female complains of palpitations. She tells you she feels nervous and tired. She has a history of a panic disorder. Her vital signs are P 100, R 24 and deep, BP 142/84, and SpO2 is 100% on room air. You should:

• A. Have her breathe into a paper bag.
• B. Assist her ventilation.
• C. Coach her to slow her breathing.
• D. Administer oxygen by non-rebreather mask.

Answer: (C)

When anxiety triggers rapid, labored breathing, the first step is to normalize her breathing pattern. Coaching her to slow her breathing helps restore CO2 levels that were being blown off during hyperventilation, which often reduces the accompanying palpitations, lightheadedness, and fatigue.

She’s alert, saturating 100% on room air, and actively breathing without signs of respiratory failure. That’s why guiding her to breathe more slowly and evenly is the most appropriate, immediate intervention. It directly addresses the likely hyperventilation from a panic reaction and doesn’t risk unnecessary interventions.

Breathing into a paper bag is not recommended here because it can be harmful if there’s an underlying hypoxia or if the patient’s condition changes; it may trap CO2 inappropriately and delay recognition of a more serious problem. Providing oxygen via a non-rebreather isn’t needed when SpO2 is already 100% and won’t correct the hyperventilation pattern. Assisting ventilation isn’t indicated because she is breathing adequately on her own.