# OPQRST questions



## SDemt32 (Apr 2, 2013)

ok, so i according to my training officer OPQRST isnt good for field assessments. 
my question is, how do i go about asking for the information that i would normally gather from doing OPQRST????????
were supposed to come back tomorrow and tell them what we would ask patients that isnt OPQRST.
Thanks


----------



## Achilles (Apr 2, 2013)

SOAP 
Subjective, Objective, Assessment, Plan


----------



## JPINFV (Apr 2, 2013)

OPQRST is one of the main mnemonics for the history of present illness (part of the subjective part of the assessment). What does your FTO suggest as an alternative? What are his problems with OPQRST?


----------



## SDemt32 (Apr 2, 2013)

JPINFV said:


> OPQRST is one of the main mnemonics for the history of present illness (part of the subjective part of the assessment). What does your FTO suggest as an alternative? What are his problems with OPQRST?



Believe me i feel the exact same way as you. along with the c/c OPQRST is gonna give me a pretty good picture of what im dealing with. 
he didnt offer any suggestions, he wants us to have "another way of ascertaining the information without using OPQRT" S is ok. 
he stated that, for example, c/c chest pain: O- not all chest pain/angina/AMI present with sudden or gradual onsets (i know, its gonna either one or the other)
P-not all AMI are provoked through exertion (physical or emotional) 
Q- not all AMI present with crushing chest pain
R- so on and so forth, i think you can see where he was going with this.

I guess he wants us to have other questions that arent obviously OPQRST because it can not give you the right diagnosis because theres been people with AMIs with no symptoms etc etc etc....

Im probably just as baffled as all you guys.


----------



## DesertMedic66 (Apr 2, 2013)

I find that OPQRST is only really useful when assessing patients who have pain. For SOB it doesn't really work too well.


----------



## SDemt32 (Apr 2, 2013)

DesertEMT66 said:


> I find that OPQRST is only really useful when assessing patients who have pain. For SOB it doesn't really work too well.



for SOB i use PASTE


----------



## JPINFV (Apr 2, 2013)

DesertEMT66 said:


> I find that OPQRST is only really useful when assessing patients who have pain. For SOB it doesn't really work too well.




Does anything make your SOB better? Worse? What were you doing when it started? Have you ever had SOB like this before? How long have you had SOB? Is the SOB better or worse than prior times you've had SOB?

Of course you're going to need to ask about associated symptoms... just like anything that isn't traumatic pain.


----------



## SDemt32 (Apr 2, 2013)

JPINFV said:


> Does anything make your SOB better? Worse? What were you doing when it started? Have you ever had SOB like this before? How long have you had SOB? Is the SOB better or worse than prior times you've had SOB?
> 
> Of course you're going to need to ask about associated symptoms... just like anything that isn't traumatic pain.



anything for pain?


----------



## JPINFV (Apr 2, 2013)

SDemt32 said:


> Believe me i feel the exact same way as you. along with the c/c OPQRST is gonna give me a pretty good picture of what im dealing with.
> he didnt offer any suggestions, he wants us to have "another way of ascertaining the information without using OPQRT" S is ok.
> he stated that, for example, c/c chest pain: O- not all chest pain/angina/AMI present with sudden or gradual onsets (i know, its gonna either one or the other)
> P-not all AMI are provoked through exertion (physical or emotional)
> ...




1. Not all acute coronary syndrome (ACS) has chest pain.
2. Not all chest pain is ACS.
3. OPQRST is a starting point, not an end point.


----------



## SDemt32 (Apr 2, 2013)

JPINFV said:


> 1. Not all acute coronary syndrome (ACS) has chest pain.
> 2. Not all chest pain is ACS.
> 3. OPQRST is a starting point, not an end point.



1, and 2 are what the FTO was getting at, thats why he wanted other questions to ask to replace OPQRST to give more insight into what could be causing the signs/symptoms c/c


----------



## JPINFV (Apr 2, 2013)

SDemt32 said:


> anything for pain?




What I mean like someone who's taking a baseball bat to the stomach is going to have different reasoning behind HPI questions than someone with a currently unknown etiology. For example, if someone with non-traumatic abdominal pain comes in, associated symptoms that you would be interested about include things like nausea, vomiting, diarrhea, skin color changes, etc. Those aren't covered under OPQRST. Someone who took a baseball bat to the stomach 5 minutes ago isn't someone that I'm expected to have a lot of associated symptoms yet, despite being able to answer all of the OPQRST questions.


----------



## JPINFV (Apr 2, 2013)

SDemt32 said:


> 1, and 2 are what the FTO was getting at, thats why he wanted other questions to ask to replace OPQRST to give more insight into what could be causing the signs/symptoms c/c



I think what he means to say then is don't stop at OPQRST, not abandon OPQRST. For example, periumbilical abdominal pain is going to be different than RLQ abdominal pain that started as periumbilical pain, which is going to be different from diffuse abdominal pain following a period of no pain that followed RLQ pain that started as periumbilical pain.

The first has a number of possible causes. The second is a classic location/radiation description of appendicitis. The third is a classic description of a perforated appy with peritonitis. The rest of OPQRST, as well as associated symptoms (and the physical exam) flesh out the chief complaint further.


----------



## Sandog (Apr 3, 2013)

JPINFV said:


> What I mean like someone who's taking a baseball bat to the stomach is going to have different reasoning behind HPI questions than someone with a currently unknown etiology. For example, if someone with non-traumatic abdominal pain comes in, associated symptoms that you would be interested about include things like nausea, vomiting, diarrhea, skin color changes, etc. Those aren't covered under OPQRST. Someone who took a baseball bat to the stomach 5 minutes ago isn't someone that I'm expected to have a lot of associated symptoms yet, despite being able to answer all of the OPQRST questions.



OPQRST would be a incomplete assessment  without SAMPLE.


----------



## JPINFV (Apr 3, 2013)

Sandog said:


> OPQRST would be a incomplete assessment  without SAMPLE.




That's why I said HPI.

Also your assessment isn't complete without a social history (at least alcohol, drugs, tobacco), surgical history, and family history... which isn't covered in SAMPLE either.


----------



## DesertMedic66 (Apr 3, 2013)

JPINFV said:


> Does anything make your SOB better? Worse? What were you doing when it started? Have you ever had SOB like this before? How long have you had SOB? Is the SOB better or worse than prior times you've had SOB?
> 
> Of course you're going to need to ask about associated symptoms... just like anything that isn't traumatic pain.



Some questions do line up with but others do not. Some parts of OPQRST can be helpful. 

Radiation: does your SOB go anywhere else? Not helpful unless there is associated pain. 

Quality: can you describe what your trouble breathing feels like? I've heard of this being helpful. I've however never had a patient who could describe how they can't breath. 

Severity: on a scale of 1 to 10 what would you rate this SOB as? Obviously you can change the wording around to make it some what helpful.


----------



## Ecgg (Apr 3, 2013)

SDemt32 said:


> Believe me i feel the exact same way as you. along with the c/c OPQRST is gonna give me a pretty good picture of what im dealing with.
> he didnt offer any suggestions, he wants us to have "another way of ascertaining the information without using OPQRT" S is ok.
> he stated that, for example, c/c chest pain: O- not all chest pain/angina/AMI present with sudden or gradual onsets (i know, its gonna either one or the other)
> P-not all AMI are provoked through exertion (physical or emotional)
> ...



When starting out with patient assessment it's best to stick with what you were thought in the books and class, and that is how you practiced. Until you become proficient with the basic assessment there is no reason to go out and try to reinvent the wheel especially when you are starting out. 

When you arrive to a call execute the game plan that you practiced, this way you will not stall 1/2 way and not know what to do next.

When I started out as an EMT-B my actual ACR had

S
A
M
p
L
E

O
P
Q
R
S
T
I     

in comments with information I obtained from the patient followed only abnormal physical exam findings. If you grab Physician assessment forms in any ER (especially teaching hospitals) all of them have the same above letters. You can't go wrong with the above. 

"In combat you do not rise to the occasion, you sink to the level of your training"


----------



## Carlos Danger (Apr 3, 2013)

Achilles said:


> SOAP
> Subjective, Objective, Assessment, Plan



That's for documentation.


----------



## Summit (Apr 3, 2013)

SDemt32 said:


> Believe me i feel the exact same way as you. along with the c/c OPQRST is gonna give me a pretty good picture of what im dealing with.
> he didnt offer any suggestions, he wants us to have "another way of ascertaining the information without using OPQRT" S is ok.
> he stated that, for example, c/c chest pain: O- not all chest pain/angina/AMI present with sudden or gradual onsets (i know, its gonna either one or the other)
> P-not all AMI are provoked through exertion (physical or emotional)
> ...



OPQRST is a useful mneumonic for gathering information about a potential AMI, but it isn't supposed to be the only tool for the reasons your instructor said. As long as you remember his caveats and know what else to investigate and ask, there is nothing wrong with using OPQRST as part of your questioning line for pain.


----------



## AzValley (Apr 3, 2013)

Summit said:


> OPQRST is a useful mneumonic for gathering information about a potential AMI, but it isn't supposed to be the only tool for the reasons your instructor said. As long as you remember his caveats and know what else to investigate and ask, there is nothing wrong with using OPQRST as part of your questioning line for pain.



+1 could not agree more with this.


----------



## jpregulman (Apr 8, 2013)

OPQRST just helps you ask the right questions. When you identify a problem make sure you ask the right questions to work on your differential. You can use what you want to remember, once you start getting a few calls you will not have to think to much about the questions to ask. For example you get abd pain. You can ask where it hurts (have them point to it), the kind of pain, if it hurts upon palp. If it is in a certain quadrant then you can start making your differential. Our service works with a lot of new EMTs we use a check off sheet that helps people ask all the right questions, if you want it you can PM me and I can send it to you.


----------



## Dan216 (Apr 8, 2013)

If you look on your skill sheets, taking a sample history and opqrst is done during transport. Not in the field - even though everyone does it anyways.


----------



## Aprz (Apr 8, 2013)

Instead of using OPQRST, you should use OLD CARTS. Then you won't be using OPQRST anymore. XD


----------

