What Qs do you ask when taking a history?

Aidey

Aidey

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Now, I know this is situational dependent, but I'm just looking for general answers.

I was taught the SAMPLES/AMPLES history, and that is standard but as time has gone and I've received more education I keep getting taught additional information you should ask. However, I haven't figured out a good way remember to all in the heat of the moment, so I'm looking for what questions you guys ask, and how you remember to ask them.
 
I was taught the AMPLE, too. Honestly, having that mnemonic helps. Sometimes I get overwhelmed and have no idea what the hell I'm supposed to do, and I just go back to all those acronyms and scenarios I've memorized...and suddenly realize the reason why we practiced all that until we were blue in the face. I immediately feel like I'm in my comfort zone. I know I probably won't disappoint the receiving hospital personnel if I only do the AMPLE.

Then, of course, are the specific histories, such as for poisoning or obstetrics.

And then you ask more questions based on what you get from your AMPLE. I.e. if a patient tells me she's taking meds for high BP, I'm gonna ask her specifically re: cardiac history and cardiac risk problems. Or, if your fairly young and healthy pt has sudden chest pain, you're gonna wanna ask about risk factors for pulmonary embolism, such as recent history of immobilization, prolonged flights. But I think you get better at these things as you become more experienced.


I think the most important part will be actually relaying the info you gathered to the hospital staff. I'm surprised at how most people I work with seem to limit their report to patient's MOI/chief complaint. It's especially useful if the patient changes their story, which happens fairly frequently, particularly with older folks, it seems.
 
All questions you ask will be related to SAMPLE / OPQRST whether you consciously think about it or not.
 
One thing I've noticed is the difference's in how people proceed through SAMPLE/OPQRST

Newbies tend to follow it letter by letter, in that order. Experienced providers tend to jump around the list in an order that is situation dependent but still manage to hit every question.
 
SAMPLE and OPQRST are the big ones. Most of my calls are med calls, but of course a lot of the latter can apply in trauma too. Asking someone with a busted arm where it hurts and how far the pain travels can tell you a lot about the extent of the injury. And knowing how much it hurts (the ol' "1-10" scale) can tell you quite a bit too.
 
ffemt8978 said:
One thing I've noticed is the difference's in how people proceed through SAMPLE/OPQRST

Newbies tend to follow it letter by letter, in that order. Experienced providers tend to jump around the list in an order that is situation dependent but still manage to hit every question.
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Amen. And sometimes I omit questions that are superfluous. It is all situation-dependent.

One of my pet peeves is a provider that stands in front of the patient and holds a clipboard, asking questions as they fill out the paperwork, without even doing a physical exam first.
 
Thanks for the replies guys :)

Right now I'm re-reading my MICP books in an attempt to brush up a little before starting my new job and going over the Pt assessment book is what has triggered this question. It lists asking about Tobacco, drugs/alcohol, travel, immunizations, work environment etc etc etc on all patients, just like allergies or medications.

Do you guys routinely ask any of these things? If you do how do you remember them since they aren't directly in the SAMPLES hx?

I know the more often I ask something, the easier it will be to remember to ask every time. Since I've been out of EMS for a few months, and I wasn't in a high volume service before that I'm a little nervous about being way behind when I start work. (They average 40,000 calls a year here).
 
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Aidey said:
It lists asking about Tobacco, drugs/alcohol, travel, immunizations, work environment etc etc etc on all patients, just like allergies or medications.
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Sounds like something you'd do on a long transport to keep yourself amused.:P Although it could definitely be a good idea for someone who you suspect might not have the greatest medical care. If they don't have a primary care physician, they may never have been questioned about their general health status in good enough detail.

But really, on half the calls, I don't even have time to finish my paperwork for the crucial stuff before we get to the hospital, let alone go into all this detail. We really aren't intended to be someone's main healthcare provider.
 
Outside of SAMPLE and OPQRST there is no real set of questions to ask every patient, those are what you need to ask every patient then you go above and beyond asking additional questions specific to their c/c.

I in no way have a lot of experience or a great foundation of knowledge in medicine but from observation it seems that the two of those play a more important role in asking the right questions than trying to memorize a list. The SAMPLE and OPQRST can generally get you close to a field diagnosis, then if you have an understanding of the disease etiology related to their current complaint you should be able to ask more directed questions to fine tune your diagnosis and come up with the best course of treatment while you have the patient. I've also been told by several medics that they adjust the order of SAMPLE depending on what the c/c is so they can get the most important questions answered off the bat so they don't have to delay any treatment and can come up with a quicker diagnosis if needed.
 
Hello ma'am/sir.. my name is Annie and I'm with the ambulance service.. so, why did you call us today?

Are you in pain? What is the pain like? How long have you had it? Have you ever had pain like this in this place before? What was it then? Have you called your doctor's office about it? What did they say? On a scale of 1 - 10, how bad is the pain? Can you point to where it hurts? (note if pt uses a finger and points to a specific spot or uses their whole hand and moves over an area) Can you describe the pain for me? Is it sharp, dull, stabbing, throbbing, achy, does it stay in one location or does it move down your arm or around your back or anywhere else?

So, when did this start? What were you doing before it started? Does anything make it better or worse? Does it hurt when you breathe in deeply? When you move it, when you cough?

did you eat dinner/lunch/breakfast today? What did you have?
Have you eaten or drunk anything unusual or new? Do you have any new meds? Are you allergic to anything?

Have you been able to move your bowels and urinate as usual today? Anything different there? Before taking the BP I generally ask them what their BP is normally if they know.

That should get you started. Of course, a lot of these questions, when answered will lead to other questions.
 
Oh, I go into bathroom habits in extreme detail every time. It is vital for me to know the color, consistency, and regularity of the patient's stool when they have a ankle Fx.

hehe.

In actuality, since I am still very green, I love the fact that I can fall beck on the SAMPLE/OPQRST when I start spinning. Than it all comes together and I start to remember things like, oh thats a symptom of...

BTW, I have heard that upwards of 70% of diagnosis is in the history. Finish it up with a strong and focused physical.
 
I stole the below table from the MA EMT-B practical assessment sheet, it should be a start for questions.


EDIT: I forgot, I ask almost every one of my patients the same 4 questions, despite the call, just to make sure there arent larger problems.

Chest Pain?
Difficulty Breathing?
Weakness?
Dizziness?
 

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I'm confident in my SAMPLES/OPQRST so I'm not too worried about remembering that.

I'm guessing that none of you guys ask anything beyond the SAMPLES/OPQRST routinely? It's all situational based?
 
BossyCow said:
So, when did this start? What were you doing before it started? Does anything make it better or worse?
Click to expand...

On chest pain calls those 3 come immediately after I introduce myself and get through the abc's.
 
I ask the questions I need answers to in case the pt crumps before we can go on.

1. What's the matter?
2. Are you allergic to any medications, foods, bites/stings, etc.?
3. Are you taking any medicatons, even over the counter ones?

Now if the pt loses consciousness we have an idea what the presenting issue was, what cannot be done without hurting the pt, and what else may be affecting the pt's condition and care.
There are niceties, such as asking "Do you remember when you got your last tetanus shot?" (and then when/where/why if "yes"), versus "When was your last tetanus shot?", and the ever-popular "Do you remember waking up?" versus/after "Did you lose consciousness?".
 
Aidey said:
Now, I know this is situational dependent, but I'm just looking for general answers.

I was taught the SAMPLES/AMPLES history, and that is standard but as time has gone and I've received more education I keep getting taught additional information you should ask. However, I haven't figured out a good way remember to all in the heat of the moment, so I'm looking for what questions you guys ask, and how you remember to ask them.
Click to expand...

-What is the problem?/Why did you call us?
-Do you have any pain?, if so where and when did it start hurting? How would you rate it on a scale of 1 to 10.
-Do you have ANY allergies? (Food, medicines, natural things) If so, what is your reaction to them?
-Do you take any medications? If so what are they for? Did you take them today? When today did you take them?
-Do you have a medical history? Any diseases or ilnesses? Any conditions prominent in your family?
-What have you had to eat or drink today? Any medicines or drugs?
-What were you doing when this happened? Why did this happen? What events lead up to this?

Gabe
First Responder
 
Jon said:
Amen. And sometimes I omit questions that are superfluous. It is all situation-dependent.

One of my pet peeves is a provider that stands in front of the patient and holds a clipboard, asking questions as they fill out the paperwork, without even doing a physical exam first.
Click to expand...

One of MY pet peeves is a practical exam evaluator that expects you to do exactly that!


Later!

--Coop
 
41 Duck said:
One of MY pet peeves is a practical exam evaluator that expects you to do exactly that!


Later!

--Coop
Click to expand...

You mean like all of them? I usually get a copy of the evaluation sheet and just try to memorize the damn thing.
 
AEIOU-TIPS is a pretty handy one too, for those that haven't heard it, works great for altered peeps.

Alcohol
Epilepsy
Insulin
Overdose
Underdose
Trauma
Infection
Psychosis
Sepsis
 
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