Opqrst
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OPQRST is an mnemonic acronym for first responders to remember key questions for patient assessment. This is usually taken along with vital signs and the SAMPLE history.
- O: Onset (this event)
- P: Provoke / Palliate
- Q: Quality
- R: Region, Radiates
- S: Severity
- T: Time (history)
[edit] Onset
What were you doing when this started? Did it start suddenly or come on gradually? You need to find out just what the patient was doing. For instance, were they just sitting on the couch watching TV or were they running on their treadmill.
[edit] Provocation / Palliation
Does anything make the discomfort better or worse? Knowing this can help you to rule out musculoskeletal injuries. A fracture will likely hurt more when palpated, whereas a sprain will probably be more constant or even alleviated somewhat by pressure.
[edit] Quality
What does it feel like? The quality of the pain would by described using terms such as shooting, stabbing, crushing, intermittent, etc. It is important to avoid asking leading questions such as "are you feeling a crushing pain that radiates into your jaw?" and instead see how the patient describes it in their own words.
[edit] Region / Radiation
Where does it hurt? Does the pain radiate elsewhere? Knowing this can give you cleaner picture of what is going on with the patient. For instance, knowing that a patient has crushing pain that radiates through the left extremities or into the jaw would give you a higher index of suspicion for a cardiac cause and help to direct your care.
[edit] Severity
How much does it hurt on a scale of 1-10 with 10 being the worst pain you have ever experienced? It is important to find out not just how much it hurts now, but also how much it hurt when it first started. It is also important to find out if the level of pain changes as a result of any interventions that are performed, such as the delivery of oxygen. A subjective numerical rating is accurate only within context; a pain rating of 7 is different if a 10 is a stubbed toe or a femur fracture.
Numerical ratings are difficult to use for many populations, such as paediatrics. For such patients, alternative scales have been devised utilizing, for example, faces, as in the Wong-Baker faces pain scale.
[edit] Time
How long has this been going on for? Has it gotten any better or worse since its onset? It is also important to find out if the patient has ever had the same thing happen before.
