Assessing dyspnea and chest pain

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DieselBolus17

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Hi all. Besides OPQRST and SAMPLE, what are your favorite questions to ask patients when assessing dyspnea and or chest pain. I feel like patient assessment (questioning) is one of my weaker areas and is probably the most important thing for us to be able to do. What are some of your favorite questions to ask? Thanks in advance. I usually start by asking:" when did this start?" "Has this ever happened before?" And "if any, where are you having pain?"
 
SAMPLE and PQRST are useful for seeing if you have forgotten anything but in and of themselves they are not a useful or complete way to take a history.

Because the differential diagnosis of chest pain and dyspnoea are quite wide I guess there's lots and lots of potential questions depending on what you think the underlying diagnosis might be. For say asthma or myocardial ischaemia it is fairly straight forward but if you have somebody who is normally well and their only complaint is "it's hard to breathe" or "my chest hurts" then this is much, much harder.

There are no "favourite" questions; the questions you ask are going to be guided by their complaint, your diagnosis and differential diagnosis.
 
Fevers/chills or coughing are nice to ask about, to ponder upon things like pneumonia.
 
Your questions should be guided by your differential diagnosis (hard to do if your a new medic). Think about what could be going on physiologically based on HPI, med Hx and medication side effects. Your line of questoning should help you rule out a few things from your differential and rule in 1 or 2.

Ask about coughing, hemoptasis, orthopnea, fever/chills as Brandon said, sick contacts, pain with inspiration, point with one do get to pain, reproducable with palpation, nasal discharge, post nasal drip, worse/better/same, pain in back, nausea, vomitting, is pain intermittent, worse after eating or lying down....

All these questions have a diagnosis in mind and the answers can stear you in one direction. But don't forget to ask about other possible Dxs even when you are sure you know what's going on.
 
Oh, and pain/cramping/swelling in the calves is good (DVT -> PE).
 
We could all give you a generalized multiple page list of questions, but as you get further in your studies you'll find what the associated S&S's are and what kind of pertinent questions you need to ask.
 
Keep clarifying questions in mind. (Does it hurt when you breathe or all the time, does position relieve symptoms. ....)
 
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