# What are your initial questions that you ask when you first interact with a patient?



## Loshi (Oct 20, 2016)

Do any of you have a script? or do you just go through the general SAMPLE and OPQRST questions?


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## VentMonkey (Oct 20, 2016)

Loshi said:


> Do any of you have a script? or do you just go through the general SAMPLE and OPQRST questions?


"What tha prollum iz??..."


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## Gurby (Oct 20, 2016)

Hi Sir/Ma'am/Miss, what's your name?
It's nice to meet you Mrs. Jones, I'm Gurby and this is my partner JimBob.
So what happened today?  /  the firefighters were saying you're having some chest pain today?  / etc

From there it's basically freestyle trying to figure out what is going on.  If you pay attention when skilled clinicians interview patients, you will find that they tend to ask pointed and specific questions rather than follow a generic script like OPQRST.  You basically start with an undifferentiated patient, and as you discover new information (is it chest "pressure" vs "stabbing" vs "burning" etc) you begin to narrow down the possibilities of what it could be.  The questions you ask will change depending on which differential diagnoses you're considering.

...and then when you think you're done, ask them, "is anything else bothering you?"  because there is almost always something else, and then you look like an idiot when the ED doc does their assessment and it turns out you missed something.


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## shfd739 (Oct 20, 2016)

Why'd you call us?


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## VentMonkey (Oct 20, 2016)

Gurby said:


> Hi Sir/Ma'am/Miss, what's your name?
> It's nice to meet you Mrs. Jones, I'm Gurby and this is my partner JimBob.
> So what happened today?  /  the firefighters were saying you're having some chest pain today?  / etc
> 
> ...


Yeah...what I said?!.

But in all seriousness, op, this is a perfect breakdown. There's no real "scribing" most of the time. I may ask the big burly fire captain to jot stuff down on dynamic calls, and/ or grab their cards, and meds and put em in a ziplock.

Again, what @Gurby said is the jist in a nutshell. Oh, and the longer you do it, the more out of order it seems, but you will know what is and is not pertinent to a specific complaint, and how to stop the patient from rabbit trailing.

The only other thing I emphasized to the newer folk was "talk-n-walk", aka, multitasking.


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## NomadicMedic (Oct 20, 2016)

"Hi, what's goin' on?"


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## VentMonkey (Oct 20, 2016)

DEmedic said:


> "Hi, what's goin' on?"


Are you detecting a theme yet, op?

This question is your ice breaker and will yield your chief complaint, you build from there.

If at first you need to write stuff down to help you remember, by all means, knock yourself out. Just try not to get into a habit of making everything a systematic approach.

No two patients are the same, and you can't fit a square peg into a round hole.


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## DesertMedic66 (Oct 20, 2016)

"What's cracking home dog"


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## VentMonkey (Oct 20, 2016)

"What it do, nephew??"...


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## STXmedic (Oct 20, 2016)

DEmedic said:


> "Hi, what's goin' on?"


That's pretty much an exact quote for me 90% of the time.


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## VentMonkey (Oct 20, 2016)

STXmedic said:


> That's pretty much an exact quote for me 90% of the time.


...samey same.


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## NomadicMedic (Oct 20, 2016)




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## VentMonkey (Oct 20, 2016)

DEmedic said:


> View attachment 3087


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## DesertMedic66 (Oct 20, 2016)

For a serious answer: it varies. If I get called to a stabbing or GSW my first question is usually "where are you shot/stabbed at?" 

If I walk into a house and see someone who is in severe respiratory distress I'm not going to ask "what's going on?" As it is already known. 

I forget to mention my name on initial patient contacts probably 90% of the time. When I remember we are usually loading the patient into the ambulance or are already transporting.


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## StCEMT (Oct 20, 2016)

"Hi, whats your name?"....unless they are OD'd on heroin or some **** and cant give a name. Then I just roll from there depending on what's going on.


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## VentMonkey (Oct 20, 2016)

DesertMedic66 said:


> For a serious answer: it varies.


One of the better takeaways from this thread thus far.


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## Handsome Robb (Oct 21, 2016)

"Hi Mr./Mrs. Smith my name is Handsome Robb, I'm one of the Paramedics on the ambulance. What's going on today?"


Sent from my iPhone using Tapatalk


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## VentMonkey (Oct 21, 2016)

Handsome Robb said:


> "Hi Mr./Mrs. Smith my name is Handsome Robb, I'm one of the Paramedics on the ambulance. What's going on today?"
> 
> 
> Sent from my iPhone using Tapatalk


"Why on earth would they call you Handsome Robb?!!"- Mr./Mrs. Smith


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## CALEMT (Oct 21, 2016)

Who is your daddy and what does he do?


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## Summit (Oct 21, 2016)

Cash or insurance?


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## CANMAN (Oct 21, 2016)

CALEMT said:


> Who is your daddy and what does he do?



You win for Kimble reference!


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## Handsome Robb (Oct 21, 2016)

VentMonkey said:


> "Why on earth would they call you Handsome Robb?!!"- Mr./Mrs. Smith



Pffffft!!!! Old ladies love me.


Sent from my iPhone using Tapatalk


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## luke_31 (Oct 21, 2016)

CANMAN said:


> You win for Kimble reference!


I wonder how many people on this board don't know this reference.


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## NomadicMedic (Oct 22, 2016)

Handsome Robb said:


> Pffffft!!!! Old ladies love me.
> 
> 
> Sent from my iPhone using Tapatalk



Even little old ladies on beta blockers get tachy when Robb is their paramedic.


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## VentMonkey (Oct 22, 2016)

CALEMT said:


> Who is your daddy and what does he do?


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## gotbeerz001 (Oct 23, 2016)

"Wha' happened?!"


Sent from my iPhone using Tapatalk


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## Akulahawk (Oct 23, 2016)

Like most, I pretty much lead off with something like "What's bothering you?" After that, I tend to, as other have said, go into more pointed questions about the patient's symptoms. Sure, OPQRST/SAMPLE does work but those are basically just a way to get the new person to cover the basics. In a way, when I'm asking patients about their problems, it may appear more like a directed conversation. Within a few minutes I'll pretty much cover all the basics while honing in on the underlying problem as much as I can. As I finish the focused exam, then I'll ask some more general questions about other body systems, more to exclude them as an issue, and then I'll finish with "Is there anything else bothering you" because often that elicits more info about the general health of the patient and their other health concerns that they may not otherwise have thought to address initially. 

Another way to put it is that we _all_ started learning how to do this using a script but with experience, we pretty much _all_ lose the script and start with open-ended questions and focus in from there.


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## ExpatMedic0 (Oct 23, 2016)

CALEMT said:


> Who is your daddy and what does he do?


beat me to it!


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## medichopeful (Oct 25, 2016)

"Hello!  I'm medichopeful, I'm one of the ER nurses here.  So what's going on today?"

If I'm working in the ICU, and the patient is able to respond or there's family there, it's generally something along the line of "Hello, I'm medichopeful and I'm gonna be your nurse for the rest of the night.  How are you feeling?"

From there, the conversation goes where it needs to go.  For example, I'm not going to ask a patient who stubbed their toe the last time they ate something, because it's almost certainly not relevant.  On the other hand, I will ask the patient who is nauseous when the last time they kept something down was.  Complaints dictate what questions I ask.


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## Akulahawk (Oct 26, 2016)

medichopeful said:


> "Hello!  I'm medichopeful, I'm one of the ER nurses here.  So what's going on today?"
> 
> If I'm working in the ICU, and the patient is able to respond or there's family there, it's generally something along the line of "Hello, I'm medichopeful and I'm gonna be your nurse for the rest of the night.  How are you feeling?"
> 
> From there, the conversation goes where it needs to go.  For example, I'm not going to ask a patient who stubbed their toe the last time they ate something, because it's almost certainly not relevant.  On the other hand, I will ask the patient who is nauseous when the last time they kept something down was.  Complaints dictate what questions I ask.


Pretty much how I do things now... minus the ICU part. Especially with elderly patients, I'll hang out for a bit and chat with the patient and/or family just to find out if the patient's confabulating things just to cover some early dementia. When family is around, it's helpful simply because they can let me know if the patient is mentating at their normal baseline while also allowing me the chance to observe the intra-family dynamics. Sometimes that can be enlightening.


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## SpecialK (Oct 26, 2016)

I be sure to ask them how they are going to pay for my services; I am highly qualified and experienced do not come cheap.

Naw I usually ask them what's wrong unless it's very clinically obvious.


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## akflightmedic (Oct 26, 2016)

"Can you hold a pen and can you sign here...?" as I extract one of the refusal forms.


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## SpecialK (Oct 26, 2016)

akflightmedic said:


> "Can you hold a pen and can you sign here...?" as I extract one of the refusal forms.



That's now much easier with ePRF; can just type "patient refused" ... no signatures required!


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## NomadicMedic (Oct 26, 2016)

akflightmedic said:


> "Can you hold a pen and can you sign here...?" as I extract one of the refusal forms.



"Press hard, you're making multiple copies..."


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## VentMonkey (Oct 26, 2016)

DEmedic said:


> "Press hard, you're making multiple copies..."


How you (I) know there's a "changing of the guards". I wonder how many newer (see younger) EMS providers will get this reference.


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## CALEMT (Oct 26, 2016)

VentMonkey said:


> How you (I) know there's a "changing of the guards". I wonder how many newer (see younger) EMS providers will get this reference.



Those of us who will start a paper PCR for the medic. Plus the fire dept still uses paper PCR's.


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## VentMonkey (Oct 26, 2016)

CALEMT said:


> Those of us who will start a paper PCR for the medic. Plus the fire dept still uses paper PCR's.


I was just talking to one of our managers about ePCR's yesterday and how by next year everyone needs to he NEMSIS compliant, so paper PCR's are, or will be obsolete.

I miss the paper charting at times, and @DEmedic's post just made me chuckle a tad.

Glad to know _some people _help their paramedics chart though.


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## CALEMT (Oct 26, 2016)

VentMonkey said:


> I was just talking to one of our managers about ePCR's yesterday and how by next year everyone needs to he NEMSIS compliant, so paper PCR's are, or will be obsolete.
> 
> I miss the paper charting at times, and @DEmedic's post just made me chuckle a tad.
> 
> Glad to know _some people _help their paramedics chart though.



We're integrating image trend in our county. Its kinda weird being able to open a PCR on my home wifi on my personal laptop and cell phone.


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## VentMonkey (Oct 26, 2016)

Again, aside from my above mentioned treatments, there's no harm in PO ASA, for me, after I have given the Zofran IVP since he's already had N/V; it's the humane thing to do.

You could try a judicious 250 ml fluid challenge, but I'd be hard pressed to go anymore than that.

Op, do you care to share your reasoning for Atropine?...aside from "ACLS guidelines" dictating such therapies?


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## CALEMT (Oct 26, 2016)

Looks like someone posted in the wrong thread


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## VentMonkey (Oct 26, 2016)

Bahaha


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## CALEMT (Oct 26, 2016)

Newb...


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## VentMonkey (Oct 26, 2016)

CALEMT said:


> Newb...


This is what happens when trying to post while on the StairMaster.


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## NomadicMedic (Oct 26, 2016)

VentMonkey said:


> This is what happens when trying to post while on the StairMaster.


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## akflightmedic (Oct 26, 2016)

Early dementia....or actually, right on time dementia.


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