Panic, Anxiety, and When It Belongs in an Emergency Room

If you are thinking about harming yourself, or you do not feel safe: call or
text 988 now. It is free, confidential and staffed around the clock. You can
also walk in here — an emergency room is a legitimate place to arrive with a
mental-health crisis, and you will not be turned away.

And the thing we most want you to know: if you are having chest pain and you
think it is probably anxiety, come in anyway.

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Why we would rather you came in

A panic attack can produce chest tightness, a pounding heart, breathlessness, a
numb or tingling face and hands, sweating, shaking, dizziness, and a genuine
conviction that you are dying. A heart problem produces the same list.

From the inside, they are often indistinguishable. That is not a failure of
judgement — it is how the body works. Telling them apart usually needs an ECG
and a blood test, which takes very little time and is the entire reason to come.

People die of heart attacks they were certain were panic attacks, and that
is the specific outcome this page exists to prevent. So:

• The first time you have symptoms like this, get checked.
• If this episode is different from your usual pattern — worse, longer, in a
  different place, or with new symptoms — get checked.
• If you are over 40, or you have blood pressure, cholesterol, diabetes,
  smoking or a family history in the picture, the threshold is lower.
• If you are not sure, that is a reason to come, not a reason to wait.

You are not wasting our time. A checked-and-clear visit is a good outcome,
and "I thought it was just anxiety" is one of the saddest sentences heard in
emergency medicine.
More on chest pain

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What a panic attack is, and what helps in the moment

It is a surge of the body's alarm system with no danger to match it. It peaks
within about ten minutes and it is not dangerous in itself, however convincing
it feels.

In the moment:

• Let it peak. Fighting it prolongs it. It passes.
• Slow the out-breath. Breathe out for longer than you breathe in. It is the
  out-breath that calms the nervous system, and most people instinctively try to
  breathe in more.
• Put your feet flat and name five things you can see. Anything that returns
  attention to the room rather than to the sensations.
• Somewhere cooler and quieter if you can get there.
• Do not drive while it is happening.

Afterwards you will feel wrung out. That is normal and it is not a sign of
damage.

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When it does belong in an emergency room

• Any chest pain you have not had checked before. See above.
• Thoughts of harming yourself, or not feeling safe. 988, or walk in.
• A panic attack that will not settle, or that keeps returning through the
  day
• Fainting, or a seizure
• Symptoms after starting, stopping or changing a medication
• Alcohol or drug withdrawal, which can be dangerous and can look like
  severe anxiety
• If you are frightened and alone and do not know what else to do. That is a
  legitimate reason to come to an emergency room at 2am, and it is a more common
  one than people imagine.

And where an emergency room is the wrong door

Being honest about this is more useful than being welcoming about everything.

We are not the right place for ongoing anxiety treatment. We can rule out
the physical causes, treat a crisis, and get you through tonight. What actually
helps anxiety long-term is therapy, sometimes medication, and continuity —
none of which an emergency room provides.

What we can do is make the referral rather than sending you away with
nothing. If that is what you need, say so before you leave. It is a reasonable
request and easier to arrange while you are here.

988 is available for anyone, not only in an emergency, and it can point you
toward local services.

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What happens when you arrive here

• A physician sees you — board-certified, every visit, at every hour.
• A heart check where symptoms warrant it — an ECG and blood tests are
  usually what separates a panic attack from a cardiac cause, and they happen
  here during the visit.
• Somewhere to be while it settles. A panic attack that is peaking does not
  need a corridor.
• Monitoring for up to 24 hours if you need watching rather than admitting.

If you need psychiatric admission or specialist crisis care, we stabilise and
arrange the transfer. We are an emergency room, not a hospital and not a
psychiatric facility, and being clear about that in advance is better than
discovering it in a difficult hour.

Nobody is going to be dismissive, and you do not have to have a physical
explanation ready to justify coming in.

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El Mirage ER — open 24 hours a day, 7 days a week, 365 days a year.
12000 N El Mirage Rd, El Mirage, AZ 85335 · (480) 237-4922
988 for a mental-health crisis · If this is a medical emergency, call
911.

This article explains when to seek emergency care. It is not medical advice and
cannot account for your history, your medications, or what is happening to you
now. If you are unsure, call us, call 988, or call 911.

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Sources

The guidance in this article about when to seek emergency care is drawn
from these public sources. Each one is linked so you can read it yourself.

• 988 Suicide & Crisis Lifeline — https://988lifeline.org/

This article is general information, not a diagnosis, and it cannot account
for your history or medications. If you are unsure, call us on (480) 237-4922
or come in. If it might be an emergency, treat it as one and call 911.

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