The patient presents with shortness of breath, inability to fill their lungs, palpitations, chest or abdominal pain, and tingling or numbness. Their respiratory rate is increased with a larger tidal volume or frequent sighing. The physical exam is otherwise normal. The patient's history may reveal an emotional trigger for the hyperventilation. The doctor should perform a brief physical exam, check pulse oximetry, explain the hyperventilation cycle and have the patient slow their breathing, use a paper bag or tubing for the patient to rebreathe exhaled air if needed to increase carbon dioxide levels and calm breathing, and consider administering hydroxyzine. If symptoms are not reversed within 15-20 minutes