EMT Assessment for Pain- OPQRST

emt OPQRST assessment

Posted By: admin March 18, 2019

During EMT school, you will learn about an assessment
mnemonic tool used called “OPQRST”. This is an assessment tool for a patient that is experiencing pain, and is information you will need to gather from the patient in certain situations. This assessment is especially useful for patients with possible cardiac problems. This is what OPQRST stands for:

  • O- Onset
  • P- Provokes/Palliates
  • Q- Quality
  • R- Radiates
  • S- Severity
  • T- Time

Onset

The “onset” of the pain is what the patient was doing when the pain started. For example, if the patient is experience chest pain, it is important to know if the patient was active (running, mowing the lawn, chopping wood, etc…) or inactive (sitting on the couch) when the chest pain started. Chest pain that is cardiac in nature is more likely to start when a person is active.

This question will also help you figure out if the pain is medical in nature, or if the person may be having pain due to some other reason. An example of this is a person experiencing chest pain that was recently lifting weights (possible muscle pain).

Example “Onset” Questions:

  • What were you doing when the pain started?
  • Were you active when the pain started?
  • Was the pain sudden or was it gradual (chronic)?

Provokes/Palliates

Finding out if anything “Provokes” or “Palliates” the pain, is asking if anything makes it better or worse. A patient that is experiencing chest pain that gets better with rest, and worse with activity may be experiencing a cardiac event (angina, M.I.).

A patient that is experiencing chest pain that hurts more when you palpate their chest (also called reproducible pain, if it is similar to the pain they were feeling before palpation) is likely experiencing muscle pain.

Palpating the patient where they are experiencing pain may help determine if the patient is experiencing pain due to a medical issue, or if the pain is musculoskeletal in nature. There are some instances that you should minimize palpating the area or not palpate at all (i.e. possible Abdominal Aortic Aneurysm, possible DVT, etc…) due to the possibility of exacerbating the patient’s condition.

Example Provokes/Palliates Questions:

  • Does anything make the pain better?
  • Does anything make the pain worse?
  • If they are experiencing chest pain, palpate the area and ask “Does this cause the same type of pain?”

Quality

The “quality” of a patient’s pain is asking them to describe the pain. Examples of this are:

  • Dull Pain
  • Sharp Pain
  • Burning Pain
  • Tearing Pain
  • Crushing Pain
  • Throbbing Pain

Gathering the “quality” of the pain helps determine what may be causing the pain. “Dull” pain that a patient cannot easily locate in their abdominal region may indicate pain from a hollow organ (stomach, bladder, etc…) while “sharp” pain in the same region may indicate pain from a solid organ “liver, kidney, etc…). “Burning” pain may indicate heart burn instead of a cardiac problem.

“Tearing” pain could indicate an aneurysm, and “Crushing” chest pain may indicate a cardiac problem. It is important to remember that people having a heart attack (M.I.) present in different ways. Someone who is not experiencing “crushing chest pain” may still be having an M.I.. Remember, these are just tools to provide clues to what is going on, not tools to “diagnose” in the field.

Example Quality Questions:

  • Can You describe the pain for me?
  • If they wont describe the pain with open ended questions, ask them closed ended questions
  • Is the pain Dull? Sharp? Crushing? Tearing? Burning?

Radiates

Asking the patient if the pain is moving anywhere, or if they are having pain anywhere else is determining if the pain is “Radiating”. Examples of this is a person having a heart attack, with pain in their arm, jaw, or epigastric pain. Patients having pain in other parts of their body may be experiencing “referred pain”.

Example “Radiates” Questions:

  • Can you feel the pain moving anywhere?
  • Are you having pain anywhere else?

Severity

This is a question to find out the “Severity” of the pain they are having. This question is completely subjective, and you will be asking a patient to rate their pain on a scale of 0-10, with 10 being the most painful (I usually describe 10 as being the worst pain they can possibly imagine).

It wont take you long to discover how many people they will tell you that they are experiencing “10 out of 10” or “12 out of 10” pain, while they are looking at you straight faced, not grimacing at all in pain (not to sound mean, but I’ve been doing this long enough to know what “10 out of 10 pain” really looks like.

In much rarer occasions, you will get someone that looks like they are about to pass out from pain tell you that they are having “5 out of 10” pain.

Just keep in mind that this is only a tool to help you figure out what is going on, and a tool to help you figure out if their pain is getting better or worse with treatment. I have had some protocols of when to give a medication for certain pain severity (example: giving nitro for a certain “chest pain” severity).

Example “Severity” Questions:

  • Can you rate your pain for me on a scale of 0-10, with 10 be the worst possible pain that you could imagine?

Time

You want to know how long the pain has been going on. Ask the patient when the pain started, and find out if the pain has been “constant” or “intermittent”. Sometimes a patient will call 911 for pain that has been going on intermittently for several weeks, that may have recently gotten worse. If a patient has been experiencing pain for a long period of time, you may need to ask more questions to find out if the patient’s pain may be caused by an injury.

“Intermittent” chest pain that gets worse during physical activity may indicate problems with the heart. Intermittent Abdominal pain that gets worse after eating a fatty meal may indicate a gallbladder issue.

Example “Time” Questions:

  • How Long Has the pain been going on?
  • Has the pain been constant or intermittent?
  • Has the pain been the same severity for the entire time?

Conclusion

The OPQRST mnemonic is a very useful tool that is easy to remember. Try to gather this information for any patient that is experiencing pain caused by a medical issue, and especially if it is chest pain. For other useful information, please check out the EMS section above. Thanks for reading!