Questions that EMS ask patients.

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onecrazykid108

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When I went through EMT school they taught me SAMPLE history and OPQRST, but I have noticed many EMTs and medics ask questions that arent part of these. I actually find it rare to hear a medic ask OPQRST besides onset. Why don't they follow these? and where do they get their questions?
 
You pick up questions as you have more experience. I've always used OPQRSTI. But I don't always ask the questions in that exact order.
 
Education and experience. The more you get, the less you stick to "First A, then B" type of questioning.


You'll find that a lot of the questions actually ARE "SAMPLE" and "OPQRST", just masked with different phrasing. Once you have assessed hundreds of patients, you begin to develop your own style... while still hitting all the main parts.




You go with the flow of the questioning, not some rigid checklist.
 
Each patient is different with different presentations and clinical priorities; as such not every question is appropriate.

The key to asking great questions is an extreme understanding of anatomy, physiology and pathophysiology to allow for considerations of differential diagnoses and creation of a working diagnosis.

For example let us consider Brown and Black are called at 2am to check out Nana's granddaughter who is staying over because she has "tummy pain".

You need to try and differentiate between ectopic pregnancy, appendicitis, gastroenteritis, spontaneous abortion (threatened, inevitable, incomplete, complete and/or retained with or without septic complications), ovarian cysts, pelvic inflammatory disease, aortic or abdominal aortic rupture, bowel obstruction or infarction, myocardial infarction, pericarditis, musculoskeletal pain, gallstones, indigestion and urinary tract infection to name but a few

The way to do that is to ask questions
 
Each patient and complaint is different if you try to fit them into a recipe youre gonna have a hard timr

Sent from LuLu using Tapatalk
 
Exactly what others have said, everyone just develops their own style over time and find it more practical to ask something right away as opposed to waiting further down the "list" in certain situations.

Like if I'm with a patient complaining of chest pain, among the first things I'm going to ask is "Has this happened before?" and if they say yes I'm going to get into their history and medications right away as opposed to not getting into those until the "M" or "P" in SAMPLE way down the acronym of questioning. Everyone just develops their own way of getting their information but in the end everything's going to be covered, it just might be in a different order or phrased/asked different than it's officially taught in books and practical assessment sheets.
 
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onecrazykid108 said:
When I went through EMT school they taught me SAMPLE history and OPQRST, but I have noticed many EMTs and medics ask questions that arent part of these. I actually find it rare to hear a medic ask OPQRST besides onset. Why don't they follow these? and where do they get their questions?
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I'm assuming they also taught you DCAP-BTLS.

Most of my quesitoning follows this pattern: what, where, how bad, when, history, medications, medical conditions, medications again (because people never know why they're on medications), etc.
 
Most of Brown's questions are based on actual clinical knowledge rather than silly acronyms
 
I always enjoy watching new EMT's at work:

Q: what happened sir?
A: I stubbed my toe
Q: When did you stub your toe?
A: about 10 minutes ago
Q: What were you doing when you stubbed your toe?
A: I was walking
Q: Did the pain come on suddenly or gradually?
A: I stubbed my toe, what do you think?
Q: Does anything make the pain in your toe better or worse?
A: * receive strange look*
Q: please describe the pain in your stubbed toe.
A: it hurts
Q: Does the pain in your toe radiate any where?
A: yes, my toe
Q: on a scale of 1-10, 1 being very little pain and 10 being the worst pain ever how bad is the pain?
A: I called you didn't I?
 
Sam Adams said:
I always enjoy watching new EMT's at work:

Q: what happened sir?
A: I stubbed my toe
Q: When did you stub your toe?
A: about 10 minutes ago
Q: What were you doing when you stubbed your toe?
A: I was walking
Q: Did the pain come on suddenly or gradually?
A: I stubbed my toe, what do you think?
Q: Does anything make the pain in your toe better or worse?
A: * receive strange look*
Q: please describe the pain in your stubbed toe.
A: it hurts
Q: Does the pain in your toe radiate any where?
A: yes, my toe
Q: on a scale of 1-10, 1 being very little pain and 10 being the worst pain ever how bad is the pain?
A: I called you didn't I?
Click to expand...

:lol:
 
Sam Adams said:
I always enjoy watching new EMT's at work:

Q: what happened sir?
A: I stubbed my toe
Q: When did you stub your toe?
A: about 10 minutes ago
Q: What were you doing when you stubbed your toe?
A: I was walking
Q: Did the pain come on suddenly or gradually?
A: I stubbed my toe, what do you think?
Q: Does anything make the pain in your toe better or worse?
A: * receive strange look*
Q: please describe the pain in your stubbed toe.
A: it hurts
Q: Does the pain in your toe radiate any where?
A: yes, my toe
Q: on a scale of 1-10, 1 being very little pain and 10 being the worst pain ever how bad is the pain?
A: I called you didn't I?
Click to expand...

I can't believe you let that out. It was my first week. :P
 
Iceman26 said:
Exactly what others have said, everyone just develops their own style over time and find it more practical to ask something right away as opposed to waiting further down the "list" in certain situations.
Click to expand...
Exactly. One major difference between an basic and a medic is that the basic is trying to get through a checklist so he can chart it. The medic is trying to get to a diagnosis so he can treat the patient. The former cannot be flexible. The latter must be flexible. And the only way to learn it is to do it, over and over and over again.
 
abckidsmom said:
Im precepting a new basic right now. I have said this so many times.
Click to expand...

Funny.. I try to tell that to my partner that's been an EMT for 10 years and recently (barely, on his 3rd attempt) got his medic...



Yup... he still believes everyone should get NRB 15l O2 and transported to the hospital... thank God I have veto.
 
I hate acronyms and mnemonics. I can sometimes remember the mnemonic, but usually have no idea what the different letters are for. I ask questions based on what I want to find out.
 
After a bit over a year on the job, I just have a conversation with my patients. Usually, the questions/answers I need to hear will surface just asking logical questions.
 
AJ Hidell said:
Go big or go home!
Click to expand...

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