# OPQRST in medical patients



## snizzle.snoozle (Apr 28, 2010)

How should I modify OPQRST for assessment of a medical patient with no pain (say, someone SOB due to an allergic reaction to a bee sting)?


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## akflightmedic (Apr 28, 2010)

Quick review time.

OPQRST is a memory device so you can recall what pertinent questions you need to ask for someone in PAIN.

If someone does NOT have pain, why would you use or modify the memory device to assess their non existent pain?

Make sense?

If someone is having SOB due to allergic reaction, we do not care about whatever minor pain they may be feeling at that time. The pain is not an emergency and it is not a life threat.

In your routine questioning, you will ask how soon the SOB occurred after the sting, but if they are related it should have been within minutes or less.


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## alphatrauma (Apr 28, 2010)

I'm guessing that a bee sting would probably elicit some sort of pain... at least it did the few times I've been stung.

Anyways, if the patient has no pain, you still work your way through the mnemonic. Just leave out what's not relevant. Shortness of breath (sans pain) can still have onset, provocation, quality, severity, etc... don't get too robotic with your questions and use common sense (ie. don't ask "does your SOB radiate?").


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## akflightmedic (Apr 28, 2010)

You are correct.

You could still work your way through it I guess but definitely do not be robotic like alpha mentioned.

Just as an aside for further discussion...we typically only use that as a memory device for pain and try to educate the students on logical progressing questions.


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## joeshmoe (Apr 28, 2010)

http://www.nremt.org/nremt/downloads/patientassessmentmanagementmedical.pdf


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## snizzle.snoozle (Apr 28, 2010)

In my class we rotate through stations to develop practical skills, and unfortunately we have not worked on assessment of medical patients as frequently as we have trauma patients. So, that's why I was curious how the mnemonic should be adapted. 

Thanks for the feedback!


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## akflightmedic (Apr 28, 2010)

No worries...keep at it.

Check that link and review it.


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## JPINFV (Apr 28, 2010)

akflightmedic said:


> OPQRST is a memory device so you can recall what pertinent questions you need to ask for someone in PAIN.



I know that's how it's taught in EMS, but I'm going to disagree that it is only for pain. OPQRST can be used for your history of present illness for most signs and symptoms, including pain. Will you use everything? No, and that's fine. Let's say the patient has a rash in addition to other symptoms. When did the rash start? Have you had a rash like this before? Does anything you do make it better/worse? Is this rash better/worse than any of them you've had before? Has the rash been growing/shrinking since you first noticed it? So on and so forth.


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## thegreypilgrim (Apr 28, 2010)

snizzle.snoozle said:


> How should I modify OPQRST for assessment of a medical patient with no pain (say, someone SOB due to an allergic reaction to a bee sting)?


Obviously you have to modify/tweak the specific questions you ask for each item in the OPQRST mnemonic for whatever chief complaint you're dealing with. In a case such as SOB s/p bee sting it'd probably go something like this:

O - Sudden onset or gradual? How much time from sting to feeling SOB?
P - Obviously in this case it was provoked by bee sting
Q - Difficulty with inspiration, expiration, or both?
R - Recurrence. Ever happened before? 
S - Severity. You can kind of estimate whether it's "mild, moderate, or severe" by visualizing the pt. Obviously you're not going to use a 1-10 scale for something like this.
T - Time elapse from onset of symptoms.

ASPN: accessory muscle use, skin wheals or rash, angioedema, Hx of need for intubation following previous episodes, etc.


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## snizzle.snoozle (Apr 28, 2010)

JPINFV said:


> I know that's how it's taught in EMS, but I'm going to disagree that it is only for pain. OPQRST can be used for your history of present illness for most signs and symptoms, including pain. Will you use everything? No, and that's fine. Let's say the patient has a rash in addition to other symptoms. When did the rash start? Have you had a rash like this before? Does anything you do make it better/worse? Is this rash better/worse than any of them you've had before? Has the rash been growing/shrinking since you first noticed it? So on and so forth.



I agree  That's how I tried to use it in one of my scenarios in class, but I got tripped up because I just wasn't sure!


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## akflightmedic (Apr 28, 2010)

JPINFV said:


> I know that's how it's taught in EMS, but I'm going to disagree that it is only for pain. OPQRST can be used for your history of present illness for most signs and symptoms, including pain. Will you use everything? No, and that's fine. Let's say the patient has a rash in addition to other symptoms. When did the rash start? Have you had a rash like this before? Does anything you do make it better/worse? Is this rash better/worse than any of them you've had before? Has the rash been growing/shrinking since you first noticed it? So on and so forth.



I agree with you, I just did not think of it that way.

I am not saying I am better than others, but when I think pain I immediately think that line of questioning. I see how it can be expanded into other lines of questioning but for those scenarios, I already have that line of questioning in my head. I do not defer/refer (?) to the OPQRST algorithm.

Not sure if I am explaining myself clear enough, just trying to say my line of questioning for anything outside of pain is easy enough to do without trying to think how I can modify the OPQRST. I do understand this is a basic class we are discussing but it is important to try and instill those critical thinking skills when possible.


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## JPINFV (Apr 28, 2010)

Sure, as with anything, OPQRST is a template. It's not an end all/be all or anything. Not all of the questions are fully relevent and additional questions should be added as need. Of course this is also where field work and class room study diverges. In general, the parts to OPQRST are worth points, and need to be hit on regardless of relevance whereas working with real patients is a much more organic experience.


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## Veneficus (Apr 28, 2010)

*comments from the paleozoic era*

SAMPLE was just AMPLE
OPQRST did not exist.
DCAPBTLS did not exist. 


Part of the danger of these memory aids is people forget they are basic templates and that more indepth lines of questioning are often called for. It also is often the limit of the questions people think there are. 

I strongly urge everyone to at least go to the library and look through a bate's guide just to see the different types of history, medical, social, etc, and how they may affect your assessment.

If you are an auditory learner, this is a good format, though language is a bit strong.

http://www.youtube.com/watch?v=FrS9JS-FtcQ


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## MrBrown (Apr 28, 2010)

Veneficus said:


> SAMPLE was just AMPLE
> OPQRST did not exist.
> DCAPBTLS did not exist.



Our new Diploma teaches SAMPLE and PQRST only, not sure about the degree.

I like a memory aid or two but too many is just crazy and they can be dangerous, I can just immagine somebody standing there with a critical asthmatic going "now when did you least eat?".


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## JPINFV (Apr 28, 2010)

You mean like this guy?

http://www.jems.com/news_and_articl...l;jsessionid=564954F81BDC0F40F55903CD639C3383


I can just see him saying, "Yes, the asthmatic died and yes his treatment was appropriate, but he didn't ask all of the SAMPLE or SOAP (yea... I don't get this one. SOAP isn't a set of questions) questions!"


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## EMTSTUDENT25 (May 19, 2010)

I agree with former posts...You must adapt OPQRST depending on the C.C. Its a guidline...Dont forget with Anaphylaxis comes possible airway compromise...crucial to get the need to know info quickly. This is what we were taught anyway.  Hope it helps!


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