This is my experience only and should not be considered definitive for you or any other individual. All novel shortness of breath (SOB) / troubled breathing (TB) events should be fully checked out and the presumptive diagnosis of respiratory or cardiac involvement must be considered until ruled out by a complete respiratory/cardiac workup. To assume SOB/TB is the result of anxiety disorder is asking for trouble.

Again, other EMS providers may have different experiences than mine, but I cannot think of a call I have had where an individual experiencing hyperventilation syndrome resulted in a lower O2 saturation. Generally, hyperventilation will “blow” off excessive CO2, since most individuals (not individuals with COPD/asthma) rely upon hypoxic drive to stimulate the desire/need to breath, without this stimulus, the body wants to slow or stop breathing, which can result in additional panic. When you hyperventilate the CO2 levels reduce and O2 levels tend to remain the same (98-100%). Decreased CO2 levels can result in respiratory alkalosis, leading to other medical issues. The signs and symptoms of hyperventilation syndrome often cause the individual to feel tingly, experience numbness in fingers, hands and feet, palpitations, cause muscle spasms and syncope (fainting).

A pulse oximeter can give a faulty reading if the patient is wearing nail polish or if blood vessels in the fingers are clamped down due to being cold. An O2 sat of 88% is pretty low for normal (non-COPD) individual and would have prodded me to consider causes other than hyperventilation syndrome.

In the old days, the individual would be asked to breath for a while in a paper bag, which would break the cycle. This practice is no longer recommended and should not be utilized. I have great success with simply calming the patient, asking them to breath with me, as I slow down my breathing, lower my voice and talk slowly, having them breath in through their mouth slowly and slowly exhale through their nose. I would say within 5 minutes most, if not all individuals experiencing hyperventilation syndrome would break the cycle.

Pete