6.3 SAMPLE and OPQRST Interviewing

SAMPLE: The History Backbone

SAMPLE is the mnemonic that organizes a patient's history into six retrievable pieces. It is used during the secondary assessment, frequently alongside vital signs and OPQRST, and it works for both medical and trauma patients.

A sign is something you can measure or see - a fast pulse, pale skin, a deformity. A symptom is something only the patient can report - nausea, dizziness, pain. The distinction between signs and symptoms is a frequent exam point. The 'P' is pertinent past history, not every illness the patient has ever had; the word reminds you to filter for what bears on today's complaint. The 'L', last oral intake, matters more than beginners expect: it informs surgery readiness, diabetic emergencies, and the risk of aspiration if the patient vomits.

The 'E', events, often reveals the true cause - chest pain that began during exertion tells a different story than chest pain at rest.

OPQRST: Unpacking Pain and Symptoms

When the complaint involves pain or a specific symptom, OPQRST drills into it and pairs naturally with the 'S' of SAMPLE.

Worked example: a patient with chest discomfort that began suddenly while resting (Onset), worsens with deep breaths or eases when sitting forward (Provocation/Palliation), feels like pressure (Quality), is central and radiates to the left arm and jaw (Region/Radiation), rates 8 out of 10 (Severity), and has been constant for 20 minutes (Time). Sudden onset, a pressure or crushing quality, and radiation to the arm or jaw are classic cardiac warning patterns the EMR should recognize and report without delay.

OPQRST turns a vague complaint into a structured story the receiving crew can act on. The same framework works for abdominal pain, shortness of breath, or a headache - asking these six questions keeps the interview organized so nothing important is forgotten under pressure. Severity, captured as a 0-to-10 number, is especially valuable because it can be trended: pain that drops from 8 to 4 after positioning and oxygen tells a story a single rating cannot.

Timing, Substitute Sources, and Vital Signs

Interviewing must be timed to the patient's condition. A stable patient with chest discomfort can answer a full SAMPLE and OPQRST set. A patient in severe respiratory distress who can speak only one or two words at a time should be asked closed, yes/no questions, and the EMR should gather history from family or bystanders instead of forcing the patient to talk. History never delays oxygen, positioning, or transport for a critical patient - treatment and interview happen together, with treatment winning every time they conflict.

When the patient cannot give a history at all - unresponsive, confused, or very young - the EMR turns to substitute sources:

• Family members, caregivers, and bystanders who witnessed events.
• Medication containers and pharmacy labels found on scene.
• Medical-alert tags - bracelets, necklaces, and wallet cards.
• Facility records for patients in nursing or care settings.

Alongside the history, the EMR obtains a full set of baseline vital signs: pulse rate and quality, respiratory rate and effort, blood pressure where trained and equipped, skin color/temperature/moisture, oxygen saturation (SpO2), pupils, and mental status. Normal adult anchors are pulse 60-100/min, respirations 12-20/min, blood pressure around 120/80 mmHg, and SpO2 of 94% or higher.

Children run faster: an infant's normal pulse may reach 100-160/min and respirations 30-60/min, so 'normal adult' numbers in a small child can be dangerously slow. A first set establishes the baseline; later sets reveal the trend, which is where the clinical meaning lives.

Interview Discipline and Common Traps

Good interviewing is as much about discipline as about questions. The EMR uses open-ended questions when time allows - 'tell me what happened' - because they surface information the responder did not know to ask for, and switches to closed questions - 'does it hurt when you breathe in?' - when the patient is short of breath, confused, or fading, because closed questions cost the patient less effort. The interviewer stays calm and unhurried in tone even when working quickly, because anxiety is contagious and a frightened patient gives worse history.

Several traps recur on the exam. One is letting the interview delay care: the right move on a critical patient is to treat and transport while gathering only the history that changes immediate decisions. Another is ignoring substitute sources when the patient cannot speak - family, bystanders, medication bottles, and medical-alert jewelry are valid and often superior sources for an unresponsive patient. A third is taking only one set of vital signs; a lone reading cannot show a trend, and trends are what reveal deterioration.

Finally, candidates sometimes confuse signs and symptoms - remember that a sign is observed or measured by the responder, while a symptom is reported by the patient. Mastering SAMPLE and OPQRST is less about memorizing letters than about asking the few questions that change what you do next.