# EMT Student SAMPLE AND OPQRST help ?



## Jesus A (Jan 25, 2014)

Hey everyone , Now im studying respiratory emergencies and cardiovascular emergencies . And and I would some expericience shared om how to asses patient with respitatory distress and cardiovascular problems. As you arrive on the scene , what are some questiom you ask for respiratory and cardio vascular . They have similar symptom ; how can you differ them ?

Thank you !!!


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## DesertMedic66 (Jan 25, 2014)

For SOB/ breathing problems I like to use PASTE. P- presentation (sudden or acute). A- associating chest pain. S- sputum production/color. T- talking (words per breath). E- exercise tolerance. I'll throw in more questions as I find necessary. 

For chest pain I'll usually go down OPQRST and dig deeper with the responses. As before Ill throw in more questions as I find necessary.


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## Aprz (Jan 25, 2014)

SAMPLE is a set of questions you are pretty much going to ask all patients; it's not specific for any type of emergency.

S - Sign & symptoms
A - Allergies
M - Medications
P - Past medical history (PMH)
L - Last oral intake
E - Events leading up to EMS being activated.

*Signs & symptoms* Signs are objective findings that the provider can see, hear, smell, etc. Examples of signs are: lacerations, cyanosis, accessory muscle use. Symptoms are subjective findings (subjective for the patient), it's what the patient tells you. Example of symptoms are "I have chest pain", "I feel short of breath", "I'm dizzy". To clarify something, what you hear is objective, but it's not consider a symptom always. Symptoms are what the patient tells you, it's what is subjective to the patient. An example of something you'd hear that is objective and not subjective is wheezing.

*Allergies* Find out what the patient is allergic to. If possible, find out what reaction they have. For example, the patient may tell you they are are allergic to latex or peanuts, and when they are exposed to them, they get hives. Some allergies aren't really allergies, but adverse effect to medications. Most common example are ACE inhibitor medications for high blood pressure (hypertension). Example of ACE inhibitors are lisinopril (prinivil/zestril), captopril (captoten), enalapril (vasotec). People will say they are allergic to ACE inhibitors, usually lisinopril, and will say that their reaction is "I start coughing a lot". It's not an allergic reaction, but it's OK to still document and report it as an allergy and tell the receiving RN "Patient said they are allergic to lisinopril, they said it gives them a bad cough".

*Medications* Ask the patient which medications they are prescribed, medications they take that are over the counter (OTC), or herbal. Check which ones they are compliant with/taking appropriately. If possible, document dose and how often they take it. In paramedic school, you may memorize which medication is associated with which medication. If you don't know, it's acceptable ask "what do you take XYZ medication for?" obtaining both a history and medication at the same time. If possible, bring medications with you to the Emergency Department.

*Past medication history (PMH)* Ask if they have any pre-existing conditions such as hypertension, asthma, epilepsy, etc. As you learn medications, you may be able to determine most of the patient's pre-existing conditions without having to ask 'em. If time permits and appropriate, ask them about surgical history, family history, and social history (ie alcohol intake, recreational drugs).

*Last oral intake* In my opinion, this is a BS question. I rarely ask it. May be important for diabetics when suspected low blood sugar (hypoglycemia) or patients who require surgery soon (ie trauma patients). Occasionally useful for other things like suspected gastroenteritis from food poisoning, but usually you'll start to suspect this based on the patient's story of the events leading up to activating EMS.

*Events leading up to activating EMS* The patient's story on what happened prior to activating EMS. Usually obtained just by listening to the patient after you ask 'em what's going on eg "I was walking my dog when all of the sudden I felt lightheaded and I guess.. I blacked out.. And then you guys were here. That's all I remember." A bit dramatic, but I hope it gets the point across.

Anyhow, SAMPLE, you are pretty much gonna do on all patients.

OPQRST and PASTE or questions that help you obtain some of the signs & symptoms (S in SAMPLE).

OPQRST is usually used for chest pain or just pain in general.

O - Onset
P - Provoking/Palliating factors
Q - Quality
R - Radiating
S - Severity
T - Time

*Onset* This is when you determine what the patient was doing when their symptoms occurred. "What were you doing when you started feeling your chest discomfort, Mr. Smith?" Things like sudden chest pain while relaxing eg sitting on a couch watching TV can be ominous.

*Provoking/Palliating factors* Things the make the patient's symptoms worse (provoking) or better (palliating). Example is a patient who sprained their ankle, walking and standing on the ankle, any weight bearing may make the symptom worse / provoke pain. For the same patient, resting, applying ice, compressing (with bandage), elevating the sprain (RICE) may decrease their pain (palliative).

*Quality* This is having the patient describe in their own words (if possible) what the pain feels like. Common examples are sharp, stabbing, crushing, and tingling.

*Radiating* This is determining if the pain has spread or moved somewhere. Common example in the classroom setting is the patient had pain in their chest, but overtime, it "radiated" to their left arm, neck, and shoulder - left arm is the most common example.

*Severity* Usually on a scale from 1 (minimal pain) to 10 (maximum pain) if possible. For some, you may have to use a qualitative scale such as no pain, little pain, moderate pain, a lot of pain, severe pain.. something like that. Assess this before and after treatment eg the patient that sprained their ankle, the pain was 7/10 on arrival, but after treating it by resting, applying ice, compressing/splinting, and elevating the sprained ankle (once again, acronym is RICE for this), the pain was reduced to 3/10.

*Time* Usually not useful for traumatic pain. This is usually asked for pain that has no obvious traumatic cause eg sudden chest pain while watching television. If the patient sprained their ankle cause they stepped into a pot hole, it's kinda dumb to ask 'em how long has the pain been occurring or when did the pain start.

PASTE (or PASTMED) is usually used for shortness of breath.

P - Provoking/Palliative factors
A - Associated symptoms (chest pain)
S - Sputum
T - Time / Talk / Tiredness
E - Exercise tolerance

*Provoking/Palliative* Refer to P in OPQRST above. What makes worsens their shortness of breath or makes it easier for them to breath?

*Associated symptoms* Usually people are taught to ask associated chest pain. Personally I believe the patient will be better served if you don't limit yourself to just chest pain. Patients complaining of shortness of breath may leave out that they are also experiencing chest pain also. Feel free to ask about things like nausea/vomiting, dizziness, pain in other locations, etc.

*Sputum* Are they coughing up anything? What color is it? What's the viscosity of it?

*Time / Talk / Tiredness* I've heard too many variations of this. Could ask how long they have been short of breath. You determine how many words they are saying between breaths. How tired do they appear?

*Exercise tolerance* How tired do they look? Can they normally ambulate? How about now? Does it worsen their breathing when they do activities like walking.

Remember, these acronyms are mnemonics. They are to help you remember things / assist you. These mnemonics are useful for beginners, but definitely do not limit your questions or thinking to these mnemonic, and you don't have to ask these questions in a specific order either. Acronyms may vary slightly to a lot depending on your location and school too so don't think that somebody is unknowledgeable because their acronym is slightly different from yours or they are not familiar with one you use. It's a memory aid, not something official. Some are more popular than others. Your assessment and thinking should become more defined and fluid as you learn more and gain more experience. Example somewhat useful question that isn't listed is "Which came first? Chest pain or shortness of breath?" Shortness of breath can cause chest pain. For suspected heart attacks (myocardial infarctions), the patient may experience some chest discomfort first, become short of breath hours later, and forget to tell you they have chest pain/discomfort. You might want to ask other things for chest pain patient's like "Do you feel nauseous / need to vomit?", "Do you have any dizziness?", "Do you have any palpitations / does it feel like your heart is racing or skipping beats?" Things like that...

Hope that helps.


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## gotbeerz001 (Jan 27, 2014)

^^^ This.


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## TheLocalMedic (Jan 27, 2014)

Not that you'd include this in your questioning during school, but it's also important to get social and family history.  Also ask about their general health/wellbeing in the last few days/weeks.  

Smoker?
Drinker?
Drugs?
Family cardiac or other history?

Sometimes family history can really influence your opinion.  When that 50 year old guy with "a little" chest pain tells you both his father and grandfather dropped dead of heart attacks in their late 40s, suddenly his symptoms appear a lot more menacing.


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## unleashedfury (Jan 27, 2014)

TheLocalMedic said:


> Not that you'd include this in your questioning during school, but it's also important to get social and family history.  Also ask about their general health/wellbeing in the last few days/weeks.
> 
> Smoker?
> Drinker?
> ...



To add depending on the dispatch I ask if the patient has had any recent medication changes or trauma. Both can help you, lead into a impression of the acute illness


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## Jesus A (Jan 29, 2014)

Thanks alot , The info given had cleared my confusion!


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