Panic attack in the practice: how to handle it

A panic attack is a storm of physical symptoms and fear that builds in a few minutes: racing heart, shortness of breath, trembling, sweating, tingling, a sense that something terrible is about to happen. The person going through it is often certain they are dying. Those watching, if they do not know what to do, tend to react with haste or panic too.

In an orofacial harmonization (HOF) practice, the scenario is not rare: needles, pain, an enclosed space, expectations about the result and, sometimes, a person who already arrives anxious. This page organizes the initial approach in terms of support and safety, and recalls the most important point: what looks like panic may not be.

Why can a panic attack happen in HOF?

Some common triggers in the practice:

• fear of needles or pain;
• enclosed space, heat or the smell of products;
• prolonged fasting or too much caffeine;
• anticipatory anxiety about a change in appearance;
• a previous traumatic experience with procedures;
• a history of anxiety or panic disorder.

An HOF medical history that asks about anxiety, previous attacks and fear of procedures lets you prepare the environment and the pace. See also anxious patient during care and anxiety before harmonization.

How do you recognize the attack?

Signs are usually physical and emotional at the same time:

The attack usually peaks within a few minutes and then fades. But that pattern is only a clue, not proof.

What should you do at the moment?

Avoid phrases like "calm down, it's nothing," "it's just anxiety" or "relax," which invalidate the experience. Grounding phrases work better: name what is happening, tell them where they are and that the team is with them.

When do you need to call emergency services?

Even when the picture fits panic, call SAMU 192 if there is:

• chest pain or pressure, especially with radiation;
• shortness of breath that worsens or does not improve;
• fainting or persistent near-fainting;
• confusion, altered speech or weakness on one side of the body;
• hives, swelling of the lips or tongue, wheezing (suspected anaphylaxis);
• a history of heart disease, diabetes or other risk conditions;
• real doubt about the severity.

In these situations, do not "test" the panic hypothesis for long. The differential diagnosis includes vasovagal syncope, hypoglycemia, hypertensive crisis, chest pain and anaphylaxis. Details on activating emergency services are in when to call SAMU.

Can I offer any medication?

Medication management is not the HOF professional's role, except when they are qualified and responsible for that type of care. The most prudent course is:

• do not offer sedatives or anxiolytics on your own initiative;
• if the patient has a prescription for attacks, let them use what they were already prescribed, following the instructions they received;
• refer for medical assessment when the attack is intense, recurrent or the first one.

Mixing sedatives with injectable procedures, anesthetics and possible interactions requires medical assessment. See also anxiolytic before an aesthetic procedure.

What about consent and continuing?

After an attack, the patient may be exhausted and vulnerable. Deciding right away whether the procedure continues is not good practice: informed consent should be given calmly and freely. In general, the most prudent approach is to reschedule, talk about what happened and, if it makes sense, suggest follow-up with a mental health professional or the treating physician.

Record in the patient record what was observed, the actions, the time, the outcome and the decision to reschedule. For the conversation, see anxious patient in the consultation, when to refer to psychology and communicating a complication to the patient.

How do you reduce the chance of another attack?

A few simple prevention measures:

Harmy can help with this preparation: by showing the patient an illustrative projection made from the frontal photo, with the plan in ml per area, they know what will be done and how many areas will be treated. This reduces uncertainty, but it does not replace support or clinical assessment.

When should you refer for follow-up?

An isolated attack tied to a clear context, such as fear of needles, does not always call for more than support and a gentler care plan. Recurrent attacks, persistent fear of having another one, avoidance of everyday situations or intense distress, on the other hand, are signs the patient would benefit from an assessment by a mental health professional or the treating physician.

The referral should be made carefully, without labels and without suggesting the patient "has a problem." Speak in terms of support: "what you went through was intense, and it's worth talking to someone who can help." Note the suggestion in the patient record and, if the patient authorizes it, leave the contact of trusted professionals. See also patient referral in HOF and care for a patient with suspected dysmorphia when the anxiety is tied to body image.

What can the team train in a simple way?

Training support is cheap and effective. In ten minutes, the team can rehearse three things: who stays beside the patient and guides breathing, who checks for warning signs and decides about SAMU, and who protects the patient's privacy and clears the room. Agree on a few standard phrases too, so nobody improvises something that invalidates the experience of the person in crisis.