Panicking Pam — Respiratory Alkalosis
Hyperventilation, numb lips, pH ↑ · PaCO₂ ↓
Pam's first panic attack lands her in the emergency department breathing forty times a minute. Her lips go numb, her hands claw shut, and the triage nurse has to decide whether this is fear or something in her lungs.
Pam blows off too much CO₂ — anxiety, pain, fever, sepsis or early PE. Numb lips, lightheadedness, carpal spasm. Labs: pH > 7.45, PaCO₂ < 35. Coach her breathing, but never assume anxiety before ruling out hypoxia and pulmonary embolism.
Read Panicking Pam's full story →The story arc
The setup
A stressful week ends with chest tightness and the sense she cannot get enough air, so she breathes faster.
The turn
Her lips and fingertips go numb; she feels lightheaded and her hands curl into spasm.
The crisis
The nurse notices her SpO₂ is 89% on room air — a detail that does not fit a simple panic attack.
The save
Oxygen goes on, a D-dimer and CT angiogram are ordered, and coached slow breathing is used only after hypoxia is excluded.
NCLEX study section — Respiratory Alkalosis
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Endocrine & Metabolic
Take this chapter into practice questions on the same topic.