SOB? Okay OPQRST.... wait... what?

Hey everybody! Nice rainy day here in Seattle, WA (shocking...), decided to do a little review of medical patient assessment until the clouds decided to part and life in the Pacific Northwest can continue.  

Line of questioning for providers is essential, especially in medical patients.  It can be the difference between knowing exactly what is going on with the patient and looking like a bafoon in the ED.  Now with trauma patients and specific-complaint medical patients, OPQRST contributes an amazing amount of guidance and servitude for the provider's line of questioning.  Abdominal pain? Chest pain? Perfect.  Done and done.  Get your SAMPLE, finish your diagnostics, confirm your suspicions, and continue to execute a care plan.  

What about vague complaints?  We've all seen these and I can bet you've been as frustrated as I when you try to fit this square peg into the round hole that is OPQRST.  OPQRST can be tweaked, sure, but it doesn't seem as... neat.  It just seemed to me that vague complaints and complaints that do not fit into the "pain" realm need a clear, guiding questioning mnemonic even more than those that do.  So one night early in paramedic school, I came up with OPRAH.  And OPRAH has served me quite well.  I will share:


  • When did the pain or discomfort begin?
  • What was the patient doing when the symptoms began?
  • Consider immediate surroundings and environment
  • Was the onset sudden or gradual?


  • Factors that make the symptoms better?
  • Factors that worsen the symptoms?


  • Have the symptoms persisted?
  • Have they become worse since onset?
  • Have they improved since onset?  Why?

Associated symptoms

  • Do other symptoms present that could be related to the chief complaint?
    • For example, patient complains about excruciating headache.  Ask about vision/hearing changes, nausea, neurologic distresses in the peripheral.


  • Has the patient experienced this before?
  • What is different today?
  • What happened last time?
  • What was the diagnosis?
  • What lifesaving measures were needed in the ED?
  • What helped last time?

So there it is guys.  Definitely recommend using this in conjunction WITH OPQRST and along with your SAMPLE, you will feel like you have your medical bases covered.  Not a end-all, but I think it's a good addition to anyone's list of alphabets! What do ya'll think?  

Time for a Starbucks run, methinks!

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Comment by Herb Lutz on May 16, 2012 at 8:32pm

Having lived in Tacoma from 80 to 84 while in the Coast Guard I do understand what it is to rust rather than tan. I like it. It is pretty much what I do but have not seen it arranged logically before. I think that alot of this simply comes with experience. When I look back I have to  smile because I'm not sure how I or my patients survived my first years as a medic. Thanks for sharing. I'll be using OPRAH as another tool when reviewing and discussing assessments. Stay dry.

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