# First most important question to ask



## Brian (Mar 31, 2010)

Can't find a definitive answer online or in my text for this one, so I'm hoping maybe someone can help me out...  What is the single most important question to ask in the SAMPLE history?  I say it would be signs and symptoms, a classmate says past medical history.  We've been going round and round on this, can anyone clarify for us? Thanks in advance.


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## LucidResq (Mar 31, 2010)

Getting a name is usually a good idea... and just asking what's going on, if it's not glaringly obvious. 

"What brings us here today?" 

If you want to examine it in textbook terms, you're weeding out their chief complaint, and signs and symptoms. 

You will find that talking to patients in real life is very different from your tests. If you assess a patient in the real world and follow SAMPLE step-by-step by the book, you will sound like an idiot. It can be useful as a template/crutch when you're first starting out to help you remember to hit all the key points, but your patient's answers and situation should ultimately guide your assessment and questions, not an acronym.


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## mycrofft (Mar 31, 2010)

*"Is that a real Rolex?"*

"Are you taking any meds? Are you allergic to any meds? What happened?". Yes/no, yes/no, then a story while you take VS and observe for mental status, respiration while talking, and sneak a closer look at the watch.

I can treat you without your name, I can kill you without your meds and allergies and c/o.


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## LucidResq (Mar 31, 2010)

mycrofft said:


> I can treat you without your name, I can kill you without your meds and allergies and c/o.



Of course, but 98% of the time there's no excuse not to get your patient's name, and I would be extremely irritated as a patient if my care provider didn't bother to ask. Referring to someone by their name builds rapport.


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## MrBrown (Mar 31, 2010)

"Hi there, I am Brown and this is Blue, whats going on today?"


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## mycrofft (Mar 31, 2010)

*"Hey, wake up, I need your name"...of course you are right, But so am I.*

Before you dip the mark's wallet to check ID, make sure he's unconcsious or he'll nail you.


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## JPINFV (Mar 31, 2010)

LucidResq said:


> Of course, but 98% of the time there's no excuse not to get your patient's name, and I would be extremely irritated as a patient if my care provider didn't bother to ask. Referring to someone by their name builds rapport.



So, I'm not supposed to just assume that my patient's name is Jane Doe?


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## LucidResq (Mar 31, 2010)

JPINFV said:


> So, I'm not supposed to just assume that my patient's name is Jane Doe?



"Hey Lady" is better


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## JPINFV (Mar 31, 2010)

LucidResq said:


> "Hey Lady" is better



[YOUTUBE]http://www.youtube.com/watch?v=620APj36WFo[/YOUTUBE]


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## Veneficus (Mar 31, 2010)

*Will this be cash or credit?*

Really though, I like to start with:

"What made you call us today?"

or in the hospital:

"what brings you to our humble abode?"


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## usafmedic45 (Mar 31, 2010)

Brian said:


> Can't find a definitive answer online or in my text for this one, so I'm hoping maybe someone can help me out...  What is the single most important question to ask in the SAMPLE history?  I say it would be signs and symptoms, a classmate says past medical history.  We've been going round and round on this, can anyone clarify for us? Thanks in advance.


"Are you sure the dog is tied up?"


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## Melclin (Mar 31, 2010)

My preferred introduction during the course of my extensive experience has been:

G'day, I'm Melclin, this is my partner Barnaby Joyce, what can we do for you. 

At uni, people will often introduce themselves: "Hi, I'm Esmarelda from the Ambulance service." and I always think.. they've called 000 for an ambulance, you've turned up in an unambiguous uniform with paramedic stamped all over it, carrying a bunch of medical stuff and there's a bloody great ambulance parked in the driveway... I think they're ganna get that you're from the ambulance service. Haha. (I do realise there may be many good reasons for announcing yourself but I just thought it was a mildly humorous observation).

While I don't know that you could say that any particular question is the MOST important, it seems to me that one of some considerable importance is the kind that queries the normality of the presentation, "Is this how your chest pain normally is", "Is this what Kevin is usually like during his psychotic episodes", "Is Barry usually a quiet baby". 

Also, I'm terrible with names, a trait that I'm trying to improve, but for me, male patients are 'mate' and female pts are 'love' until proven otherwise. Mothers are 'Mum', Fathers are 'Dad' and anyone smaller than me is 'little tacker'. B)


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## firetender (Mar 31, 2010)

*EMERGENCY is about NOW*

"What's going on with you Right NOW?"

The most important moment is the one in front of you. You can always back track.


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## Brian (Mar 31, 2010)

Thanks for all the feedback everyone, Firetender I'm inclined to agree that asking what's wrong right now is the most important thing, especially since it establishes the PT's chief complaint.  Asking about meds might be a good start also, but could also send you in the wrong direction in the treatment of a patient.


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## CAOX3 (Mar 31, 2010)

Im terrible with names.  I can remeber everything else vitals, meds and allergies.  I rarely write anything down.

Never can remember a name.  I always revert to mam or sir.


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## MrBrown (Mar 31, 2010)

Who names thier kid Barry? Ewww .....


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## xgpt (Apr 3, 2010)

I agree, try and get their name, get a chief complaint, and then just start treating/asking as you go along.


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## reaper (Apr 3, 2010)

How are you paying for this?


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## xgpt (Apr 3, 2010)

reaper said:


> How are you paying for this?



Cash or credit?


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## mycrofft (Apr 4, 2010)

*Rephrase the question. You have one minute of diminishing pt. consciousness.*

Allowing for time for the increasingly obtunded pt to think then reply, NOW tell us what the most important question(s) is/are.
Honest answers to these could be a real psychological test.


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## armywifeemt (Apr 4, 2010)

Brian said:


> What is the single most important question to ask in the SAMPLE history?



There are a few ways of looking at this, but I am going to go off of the literal meaning of the OPs initial question. He asked about SAMPLE specifically.. yes, it is a tool, a guide, and not something you will rely on for every call, especially as you gain experience... but if it weren't useful, we wouldn't learn it. As far as the most useful question, I personally think in most hypothetical situations it would be Medications... It seems to me that you could probably get answers to a lot of the other questions in SAMPLE just by asking about medications, especially if you know your pharmacology. You have a very good chance of finding out about allergies and pertinent medical history from medications... and depending on what you were dispatched for and how much information you got from dispatch, it might give you a strong indication as to what is going on. For instance... dispatched for a patient who is "acting funny" at work, and the coworkers told dispatch that their consciousness had been slowly deteriorating all day... you get there, have a barely conscious patient (situation such as what I quoted from mycrofft below) and ask them if they take any meds... say they're taking insulin... Good indication that it might be time to get a BS read and give them some glucose. 


The only problem with this whole question, especially mycroffts rephrasing of it is that the majority of the real calls we get will give us different contextual hints. So many clues on scene guide the questions you ask... and even the nature of the call. I mean responding to an MVA you're usually going to be automatically suspecting shock... possibly inebriation, especially between midnight and 5 AM... responding to a patients house, you may have medication bottles laying all over the place, or alcohol, or even drug paraphernalia. It is hard to really determine one important question.. some patients you might not even get to ask questions.. So, yeah, hypothetically you may be able to come up with an answer to this question, but in reality, there really is no one right answer. 




mycrofft said:


> Allowing for time for the increasingly obtunded pt to think then reply, NOW tell us what the most important question(s) is/are.
> Honest answers to these could be a real psychological test.


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## Needles17 (Apr 4, 2010)

Did you really spend time searching online which is important?  Signs and symtoms are mostly what you observe before you even speak to the pt.  SOB, Diaphresis, Skin Color, feeling a pulse...fast or slow...etc...  I wouldn't really consider that a question.  They are all important for a complete assessment.  You should be able to get on a track withing 60 secs after pt contact.  Sure some people blab on with every question, but just looking at your pt will usually tell you what is going on.  Maybe spend time online searching how to assess like a rock star...lol


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## eveningsky339 (Apr 8, 2010)

*strolls up to apneic, pulseless, cyanotic patient*

Hello, I'm eveningsky from the ambulance.  Why did you request an ambulance?

...

May I ask your name?

...

You having a some chest pain today?

...



*ahem*  Anyway, to address the OP, it depends on what type of service you are with.  If you are with a rural EMS agency, the first most important questions are as follows:

How much did you drink?

What brings us here today?

*after patient response*

Sweet Gravy, you did what with _what?_


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## EMSLaw (Apr 8, 2010)

While it's not a question per se, I'm interested in the whole introduction thing.  I've run with a few EMTs who don't introduce themselves, while I almost always do (well, not to the unconscious...)

So, I usually start out with, "Hi, I'm EMSLaw, I'm an EMT with Slow Boat to the ED Ambulance.  What's your name, sir/ma'am?"  "Okay, Mr./Ms. Soandso, what seems to be the problem/what brings us here tonight/how'd you get that bloody stump, and where is the rest of your leg?"

Besides, asking the patient's name is one of the first indicators I have that they're oriented.  Except when the hovering family members jump in and start answering all my questions before the patient can.

Department of Health regulations require that paid-service EMTs wear identification with their name and level of training - though interestingly, an EMT patch is optional.  Volunteers don't have that requirement, so I prefer to let them know who I am and what my qualifications are (not that most people know what being an EMT means, other than that I'm in the big ambulance and came to help.)


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## MrBrown (Apr 8, 2010)

I always introduce myself and ask (unless screamingly obvious) "whats going on today".

Although our uniforms say Technician, Paramedic or Intensive Care (as of Q1 2010) it is not common for people to use thier practice level title here.

On the name topic, some people here cover up thier surname on thier name badge if they have an old one before the option of having first name only was introduced.

Mine has both my surname and forename.


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## alyssa_ (Apr 17, 2010)

This is entirely speculation, since I'm only an EMT student with 24 hours of ridealongs under my belt, but if there's more than one person on scene... "Who called 911?" sounds like a good question, if it's not glaringly obvious.

It might be a little embarrassing to start treating the wrong person. :blush:


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## firetender (Apr 18, 2010)

Kojak's (remember Telly Savalas, the bald detective on TV?) first words to a guy who had been threatening to jump off a bridge for an hour, virtually holding a city at bay, were "Where do you want us to send your body?"


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## girlyEMT26 (May 10, 2010)

If its a cardiac patient, dont for get to ask if they have taken any sexual enhancing drugs, a little embarrassing but very important.


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## girlyEMT26 (May 10, 2010)

I was always taught to ask the patient there name and ask permission to treat. those are important.


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## EMSLaw (May 10, 2010)

alyssa_ said:


> This is entirely speculation, since I'm only an EMT student with 24 hours of ridealongs under my belt, but if there's more than one person on scene... "Who called 911?" sounds like a good question, if it's not glaringly obvious.
> 
> It might be a little embarrassing to start treating the wrong person. :blush:



This /can/ be an issue, but most of the time, especially if you respond to a private residence, it's not difficult to find the patient.  They'll be the one that looks like crap, or is standing by the door with a suitcase in hand.  

Now, when you get called to a "skilled nursing facility", it is sometimes an adventure to figure out why you're there, who your patient is, and what the patient's chief complaint may be.  "I'm sorry, so... Ms. Oldperson fell, and got back up and danced the tango, and doesn't want our help, but since she fell, your unit nurse said you /had/ to call 9-1-1?  Okay.  We'll take it from here, thanks."


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