ED pt: 58 years. Hx of schizophrenia, anxiety, MI 5 years ago, and HTN. Home meds unknown. Hyperventilating upon EMS arrival. Could control hyperventilation when asked to, but then would start again. If pt alone in room, no hyperventilation. When addressed by staff, would begin hyperventilating again, then calm down.
This continued intermittentently x 1 hour. During this time labs normal, O2 sats normal, hypertensive around 150/90ish, normal HR (80-90s). Normal urine drug screen (benzos prescribed). Chest xray normal. Kept removing O2 and roaming in halls. Ate a meal. Was very anxious but conversant. Decided to CT chest to rule out PE, on way to CT, hyperventilated entire way in wheelchair, began to sweat profusely and turn gray. Placed on monitor and prepared to code during CT. All VS normal in CT. Negative for PE. Also scanned head, nothing acute. Continued to hypervent, but level of consciousness diminished.
Upon arrival back in room, pt became apneic for 5 seconds and resumed hyper resp, then became apneic for 5 seconds again as we were preparing to intubate. Tubed quickly and placed on vent. No cardiac arrest.
MD perplexed as to the cause of all this. ABGs showed normal PO2 and low Co2. Some theorized that pt did this to himself by hyperventilating. What do you think? Any experience with this? Thanks!
