OPQRST
When we teach this in classes I’ve heard many instructors flip the meanings of these questions. Please read carefully to understand my approach to how these help my clinical judgement.
Onset - How quickly did this condition set in? Trauma - usually acute, Chest pain - all of a sudden or gradually, Stroke - all of a sudden or gradually
Provokes - Does anything improve or worsen the condition. AKA Poke em!
Quality - What does it feel like? There are over 50 words used to describe pain here are common ones. Some of these are red flags based on location during assessment.
Severity- I know we are not allowed to judge a patients pain and we can get into trouble so I like to qualify this. I’ll often use the phrase: On a scale of 0-10, 0 being no pain and 10 being mauled by a grizzly bear while lit on fire. I often get less 9s/10s and a lot more measurable pain scale. Also use descriptors in your assessment or narrative can be really helpful. Patient complains of 6/10 pain in upper abdomen. Patient grimaced and groaned on palpation. Pt is guarded. Or... Patient stated their chest pain is 10/10. Pain worse on palpation. Pain is described as sharp.
Time- This should be first and we often establish this upon our initial assessment. “Hi I’m Sam, what going on today? When did it start? Time is most important in severe trauma like tourniquets or TXA administration, and in heart attacks and strokes, remembering time is muscle. Time is so important for interventional therapy.
Onset - How quickly did this condition set in? Trauma - usually acute, Chest pain - all of a sudden or gradually, Stroke - all of a sudden or gradually
Provokes - Does anything improve or worsen the condition. AKA Poke em!
Quality - What does it feel like? There are over 50 words used to describe pain here are common ones. Some of these are red flags based on location during assessment.
- Achy
- Burning - internal vs external burning. Think Stomach acid vs Sunburn vs chemical burn.
- Stabbing or piercing
- Raw
- Cramping
- Throbbing
- Tiring
- Heavy - Distinguish between heavy and pressure. Elephant on chest vs I can’t breath my chest is squeezing.
- Tender
- Shooting
- Sickening
- Pulseating
- Poking
- Deep
- Electrical - feels like I’m getting shocked.
- Pressure
- Squeezing
- Ripping - be aware of ripping or tearing pain in back could indicate AAA.
- NUMB- I add numb as a warning sign when people say, This was hurting so bad and now it’s numb.
Severity- I know we are not allowed to judge a patients pain and we can get into trouble so I like to qualify this. I’ll often use the phrase: On a scale of 0-10, 0 being no pain and 10 being mauled by a grizzly bear while lit on fire. I often get less 9s/10s and a lot more measurable pain scale. Also use descriptors in your assessment or narrative can be really helpful. Patient complains of 6/10 pain in upper abdomen. Patient grimaced and groaned on palpation. Pt is guarded. Or... Patient stated their chest pain is 10/10. Pain worse on palpation. Pain is described as sharp.
Time- This should be first and we often establish this upon our initial assessment. “Hi I’m Sam, what going on today? When did it start? Time is most important in severe trauma like tourniquets or TXA administration, and in heart attacks and strokes, remembering time is muscle. Time is so important for interventional therapy.