Education

OPQRST in First Aid

What Does OPQRST Stand For In First Aid?

OPQRST is a mnemonic used in first aid to remember the essential questions to ask patients during an emergency. It covers the basics of what to ask when someone is having trouble. It includes O – Onset, P – Provocation, Q – Quality, R – Radiation, S – Severity, T – Time.

OPQRST stands for:

O – Onset: how quickly this occurred (e.g., “sudden”) and any warning signs

P – Provocation: what triggered the symptoms, e.g., activity; food or drink; an allergen, etc.

Q – Quality: what does it feel like (e.g., sharp, dull, tearing, burning, etc.)

R – Radiation: where does it extend to (e.g., “up the arm”), and does it go anywhere else?

S – Severity: how bad does this get (1-10 with one being not very bothersome and ten being the worst imaginable)

T – Time: how long has this been happening (how long have symptoms been present, and when did they start)?

How To Perform OPQRST?

1. Ask the patient what brings them in today. Ask for chief complaint and history of present illness (HPI). It is important to use open-ended questions as opposed to closed-ended questions. An example would be ‘could you tell me more about…’ instead of ‘do you feel….’

2. Once adequate information has been gathered, it is time to move on to the physical exam. At this point, perform a comprehensive head-to-toe examination. Once again, it is essential to use appraisal skills to collect critical data efficiently during the assessment process. This takes practice but becomes more accessible with repetition. Searching through the patient’s answers for clues about what may be wrong is called “appraisal.”

3. Interpret the patient’s responses. Once head-to-toe assessment has been completed, step back and review what was done. Make any necessary changes to the plan based on new information. Then formulate your patient’s problem list. This may be a physical or psychiatric diagnosis, but usually, it is both! Note that this will not always happen in real-time with every situation you encounter. Sometimes you have enough information already to know what the overall problem is before thoroughly examining all body systems.

4. Plan your work by prioritizing problems into manageable groups for which you can develop an organized treatment approach that will be carried out during multiple visits or across several days. This includes devising an effective plan for future treatment, usually involving a referral to another provider.

5. Teach the patient your assessment and plan, including what further information they need to gather before making any changes. Involve the patient in their care by teaching self-care skills to continue on their own once you are no longer providing direct patient care.

6. Implement your plan of care, being sure to monitor for both expected and unexpected outcomes. If something doesn’t go as planned, carefully determine how it affects the next phase of your plan until the desired result is achieved.

7. Evaluate data regarding how well it matches your hypothesis. If the plan is working, continue it for as long as necessary to achieve the desired outcome. If the patient’s symptoms are unresolved or new problems arise, go back to Step 4 and repeat developing a more effective plan that resolves these issues effectively.

8. After evaluating data, document findings along with your assessment and treatment plans in the medical record. This will help other healthcare team members understand what you did and why you did it so they can provide quality care in their interactions with this patient. It will also ensure continuity of care when another provider treats this patient later on down the road.”

Things To Consider Before You Perform OPQRST:

1. What is the Patient’s Chief Complaint?

This is typically stated in one or two concise sentences that describe why the patient sought medical attention. It may be written as a question (e.g., “My arm hurts like it does when I have the flu”). The most common problem is chest pain, which usually has more than one potential cause.

2. What Other Symptoms are Present?

A “history of present illness” is typically stated in a list of the patient’s various symptoms, which mention whether each sign began gradually or suddenly, indicates its severity on a scale of 1 to 10, and characterizes the time course (how it has changed over time).

3. What Has Been Tried So Far?

The medical history discloses all of the treatments and medications that have already been given to the patient. This includes how much was administered and when. It may also reveal allergies that affect current or future treatment plans. This section will consist of details about therapies that were effective in treating the presenting problem.

4. Is the Patient Pregnant Or Lactating?

Pregnancy and breastfeeding may impact certain treatment plans, such as administering specific medications and performing diagnostic tests. Patients should be asked about this when they first contact a healthcare provider, but it may also come up during an interview in the emergency room or during inpatient care. If the patient is pregnant, consider knowing the gestational age and expected delivery date (EDD).

5. What Language Does the Patient Speak?

Patients whose primary language differs from that of their healthcare provider may be unable to effectively describe their symptoms, making it difficult for the doctor to determine what is wrong. Healthcare providers should consider using interpreters during appointments to help bridge the language gap.

6. What Do Family Members OR Friends Say About the Patient?

This section of the medical history includes information that other healthcare providers have reported, such as how long symptoms persist and what medications (including over-the-counter drugs) the patient has taken in an attempt to make them better. There is more than one version of the patient’s symptoms since it is possible to remember them differently depending on where patients are in their illness. It may be helpful to interview multiple family members or friends.

7. What Does the Patient Expect Will Help?

Patients are often motivated to seek care because they have a diagnosis in mind. Knowing what patients expect from a particular medication or treatment may help healthcare providers avoid an unnecessary diagnostic test. Patients who seem very ill and have no idea why they are sick may need additional blood work, imaging studies, or other tests to look for another possible cause of their symptoms.

8. Does The Patient Have A History Of Abuse or Violence?

Victims of abuse and violence may be more likely to seek care for unrelated injuries and avoid healthcare settings that remind them of their past trauma. If a patient has been physically or sexually abused, they must receive support from the appropriate social services agency before receiving care. In addition, healthcare providers should consider the possible presence of partner violence when assessing women, mainly if they are pregnant.

9. The Patient’s Cultural Background

The patient’s cultural background is essential to consider in this section of the medical history, significantly if it may affect diagnostic tests or treatments for pain (e.g., performing a pelvic exam on an adult female). For example, because many people associate illness with a lack of spiritual well-being, it may be essential to determine whether the patient’s symptoms are attributed to a logical or spiritual cause.