How to manage a 20-year-old female patient presenting with a sensation of suffocation but stable vital signs (electrocardiogram (ECG) and oxygen saturation)?

Management of Sensation of Suffocation with Stable Vital Signs

A 20-year-old female presenting with a sensation of suffocation but stable vital signs should be evaluated for anxiety-related dyspnea, with appropriate oxygen therapy only if SpO₂ is below 90%, while ruling out organic causes through targeted assessment.

Initial Assessment

When a young patient presents with a sensation of suffocation despite stable vital signs (normal ECG and oxygen saturation), the approach should focus on:

Primary Assessment

• Confirm airway patency and breathing pattern
• Verify oxygen saturation (SpO₂) measurements
• Assess work of breathing: look for accessory muscle use, nasal flaring, paradoxical breathing 1
• Evaluate mental status using AVPU (Alert, Visual, Pain, Unresponsive) 1

Key Diagnostic Considerations

1. Anxiety-related dyspnea - Most likely in a young patient with normal vital signs
2. Foreign body aspiration - Rule out by examining the airway 2
3. Early pulmonary edema - Consider if there's a history of recent trauma or suffocation 3
4. Asthma/bronchospasm - Even with normal oxygen saturation initially

Management Algorithm

Step 1: Oxygen Management

• Do not administer supplemental oxygen routinely if SpO₂ is normal (≥94%) 2, 1
• Unnecessary oxygen can cause vasoconstriction and reduced cardiac output 1
• Only provide oxygen if SpO₂ <90% or PaO₂ <60 mmHg 1

Step 2: Diagnostic Testing

• Perform 12-lead ECG to rule out cardiac causes 1
• Consider bedside ultrasound to evaluate for pulmonary pathology 1
• If symptoms persist, obtain chest radiography to identify potential causes 1

Step 3: Targeted Interventions

• If anxiety appears to be the primary cause:

  • Provide reassurance and emotional support
  • Teach breathing techniques (slow, controlled breathing)
  • Consider facial cooling as a simple measure for symptom relief 1

• If symptoms persist or worsen:

  • Consider short-acting beta-agonists (e.g., albuterol) via nebulizer if bronchospasm is suspected 1
  • For severe symptoms associated with anxiety, consider anxiolytic drugs in combination with opioids 1

Important Considerations

Avoid Common Pitfalls

1. Don't miss cardiac causes in patients with primarily respiratory symptoms 1
2. Don't overlook pulmonary embolism as a cause of acute dyspnea, especially with risk factors 1
3. Don't assume anxiety without ruling out organic causes first

Special Situations

• If symptoms worsen with development of respiratory distress (respiratory rate >25 breaths/min, SpO₂ <90%), consider non-invasive positive pressure ventilation 1
• In case of foreign body obstruction (rare with normal vital signs), be prepared to perform appropriate maneuvers 2, 4

Follow-up Recommendations

• If symptoms resolve and no organic cause is identified, provide education about anxiety-related dyspnea and breathing techniques
• Consider referral for psychological evaluation if symptoms are recurrent
• Schedule follow-up to ensure complete resolution of symptoms

Remember that sensation of suffocation with normal vital signs is commonly anxiety-related in young patients, but organic causes must always be ruled out through systematic evaluation.