The usefulness of SAMPLE

[Aidey]

Branched off from this thread.

Remember also that SAMPLE is not a useful tool for taking a history; it can help you to remember if you have forgotten anything but it is in itself not a useful tool for taking a proper history.

I'll agree to a large extent. OPQRST is a good starting place, but what's important is knowing associated symptoms given a specific chief complaint. The specifics of those aren't really given any any overarching memory aid.

Well, the question was about SAMPLE, not OPQRST. I agree that knowing associated symptoms/pertinent negatives are important to know, and if you stick to OPQRST you won't always get those answers.

SAMPLE on the other hand is a very useful tool for taking history, especially if you understand that there are sub categories to the various questions.

S - Symptoms

• Associated Symptoms
• Pertinent Negatives
• Has this happened before

A - Allergies

• What is the reaction to each allergen.

M -Medications

• Recently started or stopped taking any medications.
• Recent dose changes.
• Any OTC medications.
• Any herbal/alternative medications.
• Taking them as prescribed.
• Getting medications elsewhere, like chemo treatments or at dialysis.

P - Past History

• Medical history
• Surgical history
• Social history (smoking, drinking)
• Family history
• Vaccination history (flu, pneumonia and T-DAP in adults)

L - Last Oral Intake

• Recent diet changes (over eating/under eating)
• Caffeine consumption
• Sufficient fluid intake
• Grapefruit juice (Affects many meds significantly)
• Oral antacids (also can affect med absorption)

E - Events leading up to this

• This one really doesn't have any bullet points, it is just important to get a good timeline of events. If the patient says they've been sick for "a few" days, make them define "a few" and things like that.

Some of the questions can be moved from one section to the other. Caffeine can go under social history, Grapefruit juice and oral antacids can be asked when you ask about medications.

Considering it isn't uncommon to actually be able to pick out the SAMPLE history from a patient's SOAP note written by an MD, I don't think it is useless or going to go away anytime soon.

 

[JPINFV]

Branched off from this thread.

S - Symptoms

• Associated Symptoms
• Pertinent Negatives
• Has this happened before

But what are those symptoms (and signs)? It's like saying, "Do a physical exam." Well... duh.

A - Allergies

• What is the reaction to each allergen.

M -Medications

• Recently started or stopped taking any medications.
• Recent dose changes.
• Any OTC medications.
• Any herbal/alternative medications.
• Taking them as prescribed.
• Getting medications elsewhere, like chemo treatments or at dialysis.

P - Past History

• Medical history
• Surgical history
• Social history (smoking, drinking)
• Family history
• Vaccination history (flu, pneumonia and T-DAP in adults)

I've always held that if you need a memory aid to remember to ask about medical history, allergies, and medications that you should go back to school.

L - Last Oral Intake

• Recent diet changes (over eating/under eating)
• Caffeine consumption
• Sufficient fluid intake
• Grapefruit juice (Affects many meds significantly)
• Oral antacids (also can affect med absorption)

Generally over emphasized in EMS.

E - Events leading up to this

• This one really doesn't have any bullet points, it is just important to get a good timeline of events. If the patient says they've been sick for "a few" days, make them define "a few" and things like that.

As with "symptoms," knowing what to ask and where ask further is what's important. Saying, "So what happened?" isn't deep enough, and while a very good starting place it isn't something that a licensed provider should need a memory aid for.

Considering it isn't uncommon to actually be able to pick out the SAMPLE history from a patient's SOAP note written by an MD, I don't think it is useless or going to go away anytime soon.

That doesn't mean that the thought process the physician is using to take an H&P is by thinking about SAMPLE.

 

[xrsm002]

I honestly use H.A.M.

H-hx

A-allergies

M-medication

 

[Clare]

SAMPLE is a good way to make sure you have not overlooked something that may be important but it is not a useful order in which to take a proper history from a patient.

As an example I consider it more appropriate to ask what happened (E) before asking whether the patient has allergies to medicines (A) or when they last had something to eat or drink (L) so there's your SAMPLE all mixed up already.

There are many hundreds of questions which can be asked about "signs and symptoms", "medical history" and "events preceding" the trick is knowing which ones to ask and these cannot be succinctly fit into a memory aid.

History taking is very much an art combined with the science of knowing why to ask specific questions which takes a good while to develop, mine is reasonably good but nowhere near as good as I'd like it to be.

 

[Achilles]

Generally over emphasized in EMS.

So is Oxygen :excl:

 

[VFlutter]

So is Oxygen :excl:

The last oral intake question is relevant if there is a chance the patient will require surgery but generally the gas passers just want to know if and when they ate. They don't really care about the specifics of what they ate.

 

[JPINFV]

The last oral intake question is relevant if there is a chance the patient will require surgery but generally the gas passers just want to know if and when they ate. They don't really care about the specifics of what they ate.

Even still, the problem is that there are two options. Either the patient can wait 6 hours, or the patient can't wait 6 hours for surgery. It's one of those things where anesthesiology can wish for an empty stomach all they want, but if the patient has to go up now, then their just SOL.

 

[VFlutter]

Even still, the problem is that there are two options. Either the patient can wait 6 hours, or the patient can't wait 6 hours for surgery. It's one of those things where anesthesiology can wish for an empty stomach all they want, but if the patient has to go up now, then their just SOL.

Agreed but there are many approaches to anesthesia and the NPO status can be the difference between a PNB, MAC with a LMA, or getting intubated for deep GA. However, the CRNA/MDA will most likely interview and assess the patient themselves so not really important for EMS to address in detail.

 

[EpiEMS]

Branched off from
L - Last Oral Intake

• Recent diet changes (over eating/under eating)
• Caffeine consumption
• Sufficient fluid intake
• Grapefruit juice (Affects many meds significantly)
• Oral antacids (also can affect med absorption)

Do you find yourself often asking about "last output," as it were?

 

[CritterNurse]

In class we were taught that the S in sample was the OPQRST, and then go onto the AMPLE part.

Generally, I try to stick to:
What happened?
When?
How long/bad?
What meds/supplements do you take?
Do you have any allergies?
What do you have for medical history?
Where do you want to go?

 

[Sandog]

I've always held that if you need a memory aid to remember to ask about medical history, allergies, and medications that you should go back to school.

Well, we are not all special. For early entry EMT's, when situations arise that are stressful, simple things like SAMPLE help one remain focused on asking the right questions.

 

[abckidsmom]

Not long ago I came to an abd pain call and the volunteer first responder was a person with decades of EMS experience, at least two as an ALS educator. She had a piece of paper with SAMPLE down the left side and all filled out with details.

My partner and I laughed a bit, and as a joke for a few calls he kept the paper filled out like that and nagged me because I never asked the questions in order.

 

[mycrofft]

What, you folks never were woken up at 2 AM and drove code three for two blocks then expected to remember everything?

Whatever lucky charm you need, use it, and using a standard format can greatly help the receiving staff/billing people. BUT, what about when you don't have the time such as the pt is obtunded and sinking, or getting cagey? Will "S,A,M" or" S plus 1/2 A" do it?

Urgent histories are like a fight, get your best licks in fast. Allergies, meds, name, chronic malfunctions/current event while doing VS, then get the rest. And for Gosh sake write it down.