OPQRST

OPQRST is a mnemonic used to evaluate a patient’s symptoms. Remember to ask the patient exactly where the complaint is prior to evaluating the symptom! For example, if a patient complains of chest pain, you should ask them to point to exactly where they are having their pain. It could be off to one side, substernal, etc, and it is important to determine the exact location. Note that the mnemonic works nicely for pain, and it can also be used to evaluate symptoms such as nausea, dizziness, and weakness with a bit of modification.

Onset · What was the patient doing when it started? · Example: “My chest pain started right after walking up a flight of stairs.”

Provocation/palliation · What makes the symptom worse (provocation) or better (palliation)? · Example: “It feels better when I sit down and rest, but only a little bit.”

Quality · Can the patient describe the symptom? o Descriptors for pain: . Sharp, stabbing, dull, pressure, constant, intermittent, throbbing, aching · Example: “It’s a sharp, constant pain,”

Radiation · Does the symptom start in one location and radiate to another? · Example: “The pain radiates from my chest into my left shoulder.”

Severity · Scale of 0-10, with 0 being no symptom and 10 being the worse that the symptom could be. · Example: “The pain is a 6 now that I’m resting, down from a 9 immediately after walking up the stairs.”

Time · Exactly what time the symptom start (the symptoms that caused the patient to dial 911), and how long total? · Example: “It started about 9 a.m., or about 35 minutes ago, and hasn’t stopped.” SAMPLE

Signs and Symptoms • Signs: Look for: o Pale skin o Diaphoresis o Cyanosis o Altered mental status o Etc…. • Symptoms: o Chest pain o Difficulty breathing o Dizziness o Nausea/vomiting o Weakness o Syncope (passed out?) o Abdominal or back pain o Headache Allergies • Medications? o If yes, what happens? • Environmental? Medications • Any prescription medications? o Are they compliant with medications they are supposed to be taking? o Were they prescribed the medication, or are they self-medicating? • Any herbal meds? • Any over-the-counter medications? • Illicit drugs or alcohol? Past medical history • Be specific: o Cardiac problems? o Breathing problems? o Stroke? o High blood pressure? o Kidney disease? o Seizures? o Diabetes? Last oral intake • Food & water Events • Take this opportunity to clear up any questions about the event.